Richard L. Frierson

Psychiatric and Neurological Characteristics of Murder Defendants Referred for Pretrial Evaluation

After literature review, this paper presents the largest study to date (n = 270) of psychiatric and neurological characteristics of accused murderers in the United States. This retrospective record review of pretrial detainees undergoing competency to stand trial and criminal responsibility evaluations examined demographic characteristics, psychiatric diagnosis, substance use patterns, Intelligence Quotient (IQ), and results of electroencephalogram (EEG), neuroimaging (MRI or CT) and neurological examination. Substance use and mood/adjustment disorders were common. Neuroimaging was abnormal in 18% of subjects and was associated with lower Performance IQ. EEG and neurological exam findings were not associated with measured cognitive impairment. While 16% of subjects had a FS IQ < 70, only 6% were diagnosed with mental retardation. Subjects with a psychotic disorder (p = 0.001) or an anxiety disorder (p = 0.005) were more likely to use a knife than other subjects in the study. Violence risk assessment in these patients must not only involve inquiry about firearm availability.

The Presence of Low IQ and Mental Retardation Among Murder Defendants Referred for Pretrial Evaluation

ABSTRACT: After an overview of definitions of mental retardation and recent case law regarding mental retardation and the death penalty, this paper presents a study of factors associated with a mental retardation (MR) diagnosis among murder defendants. Subjects with a full‐scale IQ≤70 (n=42) were compared with other pretrial murder defendants (n=228) referred for forensic evaluation over a 5‐year period. Subjects with an IQ≤70 who were diagnosed with MR were compared with subjects with an IQ≤70 who did not receive this diagnosis. Female murder defendants were more likely to receive a diagnosis of MR (p=0.03). MR was also more commonly diagnosed in subjects with an Axis I cognitive disorder (p=0.018). Having an IQ≤70 was more common in subjects with a psychotic and substance use disorder (p=0.03) and did not necessarily lead to a diagnosis of MR in this subgroup. Implications for diagnosing MR among murder defendants are discussed.

Principles of suicide risk assessment. How to interview depressed patients and tailor treatment.

PREVIEW Suicide is a significant cause of death in the United States. Because many patients who commit suicide visit their primary care physician in the weeks before their death, physicians need to be familiar with suicide risk assessment techniques. In this article, Drs Frierson, Melikian, and Wadman discuss the demographics and risk factors of suicide and propose a methodical, practical approach to assessing and managing suicide risk in depressed patients.

Forensic Psychiatry Milestones: Experience After 1 Year

ObjectiveIn 1999, the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties identified six core competencies for medical practice. In 2013, the milestones were introduced to demonstrate these educational outcomes across each specialty. This study represents the first examination of the sub-specialty Forensic Psychiatry Milestones.MethodsMembers of the Association of Directors of Forensic Psychiatry Fellowships were surveyed. Areas of inquiry included whether milestones assisted in identifying areas of deficiency in fellows or programs, whether the graduation milestones matched the goals of training, and what changes were planned, or had been made, based on their implementation.ResultsTwenty-six of 35 programs responded, for a response rate of 74%. The majority found the milestones somewhat or very useful, half found the graduation-level milestones matched the program’s graduation goals, and a significant majority reported that the milestones assisted in identifying improvements, change, or intended change. In choosing terms to describe the milestones, however respondents chose a variety of negative or neutral terms, rather than positive ones.ConclusionsThe milestones provided a standard mechanism for identifying areas for improvement and a common language to standardize practice. However, due to the variability across fellowship programs and the limitations of educational resources and time, implementation of the new ACGME requirement was characterized in largely negative terms. Recommendations for improvement included modification of the milestones themselves, flexibility in their implementation, and evidentiary support for their use.

Legal Aspects of Dementia

Publisher Summary This chapter discusses methods used to evaluate patient capacity in a variety of decision-making areas. The chapter presents two models of medical decision-making in incapacitated patients: advance directives and health care proxies. The legal aspects of guardianship and conservatorship and the implications of cognitive impairment on testamentary capacity are also discussed. The chapter provides an overview of elder abuse law, which is discussed in detail. It concludes that all of the legal issues in dementia are centered in the concept of parens patriae. It is translated as “parent of his or her country.” This concept reflects the governments capacity to be a provider of protection to those unable to care for or protect them. While patient autonomy remains an important aim for the elderly, advanced directives, health care proxies, guardians, conservators, and elder abuse reporting, laws share the common goal of preventing the exploitation and harm of elderly citizens. The chapter reviews that these measures partly rely on physicians and other health care professionals for their implementation. As the percentage of elderly as a total of the world population continues to increase, physicians should familiarize themselves with these legal issues in an effort to provide better care for the demented patient.

Implications of Pseudologia Fantastica in Criminal Forensic Evaluations: A Review and Case Report

Pseudologia fantastica, a psychological phenomenon that has been described in the literature for at least a century, is an understudied and poorly understood entity. Sometimes referred to as pathological lying, pseudologia fantastica involves disproportionate fabrication that may be present for many years or a lifetime. In a forensic context, it can significantly complicate the evaluation of capacity to stand trial and, in certain jurisdictions, criminal responsibility. We review the current literature regarding pseudologia fantastica and present a case to highlight the clinical and forensic challenges it may create. We specifically discuss the complications that pseudologia fantastica may have on the assessment of a defendants rational ability to consult with an attorney, a required element of capacity to stand trial. In addition, we discuss the implications of pseudologia fantastica in the evaluation of criminal responsibility.

Amnesia for a Capital Offense and Competency to be Executed

In Dunn , Commissioner , Alabama Department of Corrections v. Madison , No. 17–193 (U.S. November 6, 2017), Vernon Madison was convicted of murder and sentenced to be executed. While incarcerated, he had two strokes that resulted in cognitive impairment. Mr. Madison requested a competency to be