Ryan C. W. Hall

Abuse of supraphysiologic doses of anabolic steroids.

The following article is a literature review of supraphysiologic doses of anabolic-androgenic steroids (AAS). This article contains a brief review of the history of AAS, the chemistry of the varying forms of AAS, and proposed mechanisms of action. The article then focuses on how AAS are used in an illicit manner by the general population. Terms such as “stacking” and “pyramiding” are discussed. The article concludes by looking at the major detrimental side effects, such as liver damage and cardiovascular changes, which physicians may encounter when treating AAS abusers.

Atypical neuroleptic malignant syndrome presenting as fever of unknown origin in the elderly.

A 79-year-old nursing home resident who was taking olanzapine presented to multiple hospitals with fevers of unknown origin. After an extensive workup to rule out infection, the patient was diagnosed as having neuroleptic malignant syndrome (NMS). This patient’s presentation was atypical because of the lack of rigidity or tremor at the time of admission. This case highlights the importance of including NMS in the differential diagnosis of fever of unknown origin in medical patients. A review of the medical literature is taken, focusing on diagnoses, prevalence, predisposing factors, pathophysiology, and current treatment approaches for NMS.

Petalz: Search-Based Procedural Content Generation for the Casual Gamer

The impact of game content on the player experience is potentially more critical in casual games than in competitive games because of the diminished role of strategic or tactical diversions. Interestingly, until now procedural content generation (PCG) has nevertheless been investigated almost exclusively in the context of competitive, skills-based gaming. This paper therefore opens a new direction for PCG by placing it at the center of an entirely casual flower-breeding game platform called Petalz. That way, the behavior of players and their reactions to different game mechanics in a casual environment driven by PCG can be investigated. In particular, players in Petalz can: 1) trade their discoveries in a global marketplace; 2) respond to an incentive system that awards diversity; and 3) generate real-world 3-D replicas of their evolved flowers. With over 1900 registered online users and 38 646 unique evolved flowers, Petalz showcases the potential for PCG to enable these kinds of casual game mechanics, thus paving the way for continued innovation with PCG in casual gaming.

Psychopathology in a galaxy far, far away: the use of Star Wars' Dark Side in teaching

Star Wars is well known, timeless, universal, and incorporated into shared culture. Trainees have grown up with the movies, and based on their enduring popularity, attending psychiatrists are likely to have seen them too. This article highlights psychopathology from the Dark Side of Star Wars films which can be used in teaching. These include as follows: borderline and narcissistic personality traits, psychopathy, PTSD, partner violence risk, developmental stages, and of course Oedipal conflicts.

Using Star Wars’ supporting characters to teach about psychopathology

Objectives: The pop culture phenomenon of Star Wars has been underutilised as a vehicle to teach about psychiatry. It is well known to students, registrars, and consultants alike. New Star Wars films are expected out in 2015, which will likely lead to further popularity. The purpose of this article is to illustrate psychopathology and psychiatric themes demonstrated by supporting characters, and ways they can be used to teach concepts in a hypothetical yet memorable way. Conclusions: Using the minor characters as a springboard for teaching has the benefit of students not having preconceived notions about them. Characters can be used to approach teaching about ADHD, anxiety, kleptomania and paedophilia.

Gender Considerations in Violence

The role of gender in violence is poorly understood. Research has shown that gender has an important and, at times, distinct role in the prediction of violence. However, this gender disparity diminishes in the setting of mental illness. The risk assessment of violence in women is largely based on research in violent men. There are distinct characteristics in female violence compared with male violence. Attention to these characteristics may lead to the development of gender-dependent tools that can be used to evaluate violence risk.

Involuntary Treatment of Psychosis in Pregnancy

When a patient with acute psychosis refuses antipsychotic medication despite a clear need for treatment, involuntary medication is often considered. When the patient is both pregnant and acutely unwell, an additional layer of analysis enters the picture. This analysis then also includes the health of the mother and fetus, rights of the mother and fetus, and whose rights take precedence when choosing treatment options in event of a conflict. Antipsychotic agents are frequently the medications prescribed as involuntary treatment. Typical and atypical antipsychotic agents are often used in both emergent and nonemergent situations during pregnancy. Despite a lack of randomized, double-blind, controlled, prospective studies in pregnancy, available data regarding the safety of antipsychotic agents in pregnancy are relatively reassuring. At the same time, the risks of untreated psychosis, for both the mother and the fetus, are not negligible. Such cases merit ethics-related and legal analyses. Forensic psychiatrists involved in such cases need to consider the patients capacity to make medical decisions and be able to discuss the potential risks, benefits, and alternatives with patients and in court, as part of initiation of involuntary treatment.

The Last Jedi Takes His Own Life: Rational Suicide and Homicide-Suicide in Star Wars

Star Wars films have been used to teach about psychiatric disorders ranging from obsessive-compulsive personality disorder in C3PO to psychopathy in Jabba the Hutt to malingering by Yoda [1–3]. This has continued into the new trilogy with The Force Awakens being used as a case study to discuss patricide [4]. In a similar vein, The Last Jedi, which contains multiple examples of self-sacrifice, allows for discussion of the difficult topics and themes inherent in suicide and homicide-suicide. Although Star Wars is a science-fiction space opera transcending multiple generations, one must not forget that it is also about war and death. Even popular characters do not always live to see another day (e.g., Han Solo). In this paper, we discuss how The Last Jedi can be used in psychiatric discussions with trainees to address the real-world topics of suicide and homicide-suicide through the hypothetical lens of popular culture. Motivations such as honor, duty to comrades, political/terrorism, personal vulnerability, and confronting mortality in advancing age are all present. It is hoped that these sometimes difficult themes and concepts can be more freely explored through a fictional universe. Our review will examine examples of suicides, attempted suicides, homicide-suicides, and acts of desperation in the order in which they occurred in the film.

Frequency and Detection of Malingering in Homicide Defendants Undergoing Criminal Responsibility Evaluations Using the Schedule for Nonadaptive and Adaptive Personality

This retrospective study reports on (a) the prevalence of malingering in a sample of 20 homicide defendants seen in jail settings for criminal responsibility evaluations, and (b) the feasibility of the Schedule for Nonadaptive and Adaptive Personality (SNAP) for malingering detection in this sample. Based on previous non-clinical simulation research, it was hypothesized that the SNAP validity scales would predict group membership for homicide defendants malingering psychopathology. Those with intellectual disabilities or psychotic disorders were excluded. Diagnostically, nearly one half of the sample had Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) personality and substance use disorders. Point prevalence of malingering was 30%. Using the criterion of any SNAP validity scale score in the clinical range (T ≥ 65), a reasonable sensitivity was demonstrated in the detection of malingering (83%), yet this outcome was hindered by a high false positive rate (64%). This study suggests further exploration of the SNAP for assessing malingering in forensic populations is warranted.