Stephen B. Billick

Competency to consent to treatment.

Competency to consent to treatment is an especially critical determination to make in the field of psychiatry. Psychiatric patients are often capable, despite their illness, of self-advocacy. Careful assessments are required to differentiate competent patients from incompetent patients. Moreover, the character of their illness, from psychosis to organic brain disease, has been found to correlate with a lack of competency. The presence of auditory hallucinations or delusions, however, are not pathognomonic of incompetency. Currently, there exists no standardized method to establish competency, either in psychiatric or in medical patients. This is a review of the several instruments developed by various researchers attempting to create one. It finds promise in several questionnaires that have good inter-rater reliability and validity.

Mental Health Approaches to Child Victims of Acts of Terrorism

It has long been recognized that human beings exposed to severe stress may develop psychological symptoms. With recent terrorist acts around the world including the New York City World Trade Center September 11, 2001 atrocity, there has been a growing interest in the specific impact of terrorist acts on the victims and witnesses. One area that has received less study is the specific impact on children. This paper reviews some of the general effects of traumatic stress on children and the history of the research in this area including a specific discussion of post-traumatic stress disorder in children. This is followed by a review of how children might react to the trauma of a terrorist attack differentiating between three different subgroups of children (preschool age children, school-age children, and adolescents). Then there is a review of what a comprehensive evaluation of childhood victims of terrorism should entail. Finally, treatment modalities that have been shown to be effective are reviewed.

Ophthalmologic Screening in 25 Consecutive Geriatric Psychiatric Inpatient Admissions

Abstract In the aging process, people are at increasing risk of visual abnormalities such as cataracts, glaucoma, age-related macular degeneration, and other retinal defects. This holds true for geriatric psychiatric patients as well. These ophthalmic problems may increase risk of falls or increase the comorbidity from dementing processes and depression. Geriatric patients presenting for psychiatric treatment may also be misdiagnosed or under-diagnosed as a result of these visual problems. This quality assurance review of 25 consecutive geriatric psychiatric inpatients demonstrated discrepancies between chart documentation and actual ophthalmologic pathology present in the patients. Doing a simple but complete ophthalmologic screening as part of the general physical examination on admission to an inpatient psychiatric unit can identify those patients who will need more in depth examination of their eyes and promote more accurate differential diagnoses for the patients.

Overlapping universe: understanding legal insanity and psychosis.

The Insanity Defense of Not Guilty by Reason of Insanity is the defense used by some mentally disordered defendants who do not have the capacity for understanding right and wrong at the time of their criminal act. This defense has perplexed legal and mental health professionals for centuries. Though it has been a part of the legal system since the early Greeks, it has been and continues to be amended, modified, and in some jurisdictions, abolished. Moreover, despite its infrequent use, many in our society hold onto the belief that defendants can evade criminal responsibility by means of this defense. Furthermore, insanity is often equated with psychosis; however, the two are not the same and have different connotations. It is essential for any clinical psychiatrist to understand the concept of the insanity defense and how it differs from psychosis. This paper will clarify the meaning and purpose of the insanity defense and will differentiate insanity and psychosis.

Confounding Psychosis in the Postpartum Period

This case report alerts the psychiatric clinician to consider nonpsychiatric etiologies of psychosis appearing during the postpartum period besides postpartum psychosis. The case includes a description of the patient’s psychiatric presentation, admission to the inpatient psychiatric unit with subsequent transfer to the medicine department including neuroimaging and neurological consultation. The patient had a remission of psychosis after only two and half days of antipsychotic medication administration. Positive findings on the MRI suggested a demyelinating disease and a 4-month follow up MRI continued to be positive. The etiology was presumed to be a demyelinating disease. In conclusion, psychiatrists need to be alert to include nonpsychiatric pathologies in the differential diagnosis when a patient presents with psychosis in the postpartum period.