An interdisciplinary team approach to assessment and treatment planning is often necessary when evaluating persons with ID. The psychiatrist may not be able to rely on the evaluee's self-report. When considering culture as part of the case formulation process, the forensic psychiatrist must first identify the traditions, values, and behavioral norms of the evaluee that are pertinent to the consultation questions. These tools can act as an aide-mmoire for the evaluator. Actuarial tables are designed to distinguish people with long life expectancies from those with short ones. The quintessential actuarial tests are those established by the life insurance industry to assign insurance rates to its clients. << Because of the complexities involved in concluding with reasonable medical certainty that a patient is malingering, a comprehensive malingering assessment may be considered, particularly in difficult cases.193,207,209,210 An outline for the comprehensive assessment of malingering is given in Summary 10.5.3. Emotional injuries that can result in a mental injury are wide-ranging and include the loss of a parent or close relative, witnessing harm caused to others, and being verbally victimized (such as taunts associated with sexual harassment, bullying, or threats from others). Allegations involving double denial conform to the following theme: I am not responsible because of reason one, and, if this is not accepted, I am also not responsible because of reason two. Genuine insanity defenses are usually associated with only one psychotic explanation of why the defendant did not appreciate the wrongfulness of the act, not with dual explanations. Systematic inquiries are especially helpful in obtaining a full substance use history. American Academy of Psychiatry and the Law (AAPL) One Regency Drive P.O. Disability assessments generally require an evaluation of how the claimed psychological symptoms (such as a depressed mood or impaired concentration) affect the person's ability to work. Making this determination requires a history of psychiatric symptoms before and right up to the time that the evaluee waived his rights. In general, the evaluator should review relevant documents as they become available. It is advisable to inform collateral contacts that everything said is on the record and may be used in open court and made public, so that they can consider in advance what information to share. The relationship between diagnosis and impairment is complex, and there can be psychiatric and legal overemphasis and reliance on diagnosis rather than on the assessment of functioning.101 Providing a DSM diagnosis does not substitute for conducting a careful functional assessment. Self-report measures of sexual behavior and attitudes provide another window into the mind of the evaluee.240 Other investigations include sexual preference testing by PPG and VRT (see Section 8.6, Penile Plethysmography and Visual Reaction Time Screening). Strategies noted by respondents to the survey by Leavitt and coworkers63 included keeping doors to the interview room open, having a third party close by, and informing others of one's whereabouts. During the assessment, the forensic psychiatrist should consider differential diagnoses and be prepared to testify concerning the reason for the diagnosis vis--vis other possible diagnoses that would be more or less favorable to the evaluee's case. These considerations do not require evaluators to abandon their usual approach completely; rather, they should adapt their usual approach to fit the unique circumstances. After the expert obtains informed consent for the assessment, the evaluee should be given an opportunity to ask questions regarding the process. If a forensic opinion is offered through the sole use of collateral sources, the evaluator must inform the court in both writing and testimony that a personal examination was attempted and was unsuccessful and that the opinion is being offered through the use of collateral sources. The history should provide a longitudinal review of personal, academic, social, and occupational functioning.54 An individual's account of early developmental delays, even in the absence of corroborating collateral information, combined with evidence of functional impairments, may provide information relevant to case formulation. Tests of endocrine function, which may include tests for diabetes and thyroid disease and specific levels of sex hormones, are sometimes indicated.239 Neuropsychological testing by a psychologist, electroencephalography, and imaging studies can identify a variety of brain diseases that may have prognostic implications. Recognizing affect, validating it when appropriate, and encouraging the evaluee to discuss feelings can reduce the risk of violence. A sexual history should include an assessment of gender identity, sexual orientation, and sexual dysfunctions. The complaint is usually countered by a list of specific questions (interrogatories) from the defense, followed by the plaintiff's answers to these interrogatories. Sometimes it is necessary to interrupt an evaluee who may want to move on to other subjects, to ensure that he accurately describes his memories of to the time point of interest. The evaluator should summarize information about job performance, attitude about working in current and previous jobs, consistency between reported symptoms and descriptions of daily activities, and the results of psychological and neuropsychological tests in assessing secondary gain, exaggeration, or malingering. The forensic psychiatrist also may have to determine the treatment necessary to improve the evaluee's level of functioning and whether additional or different treatment is likely to help.136 This analysis could be appropriate in a variety of civil (e.g., disability, fitness for duty) and criminal (e.g., sentence mitigation, risk for recidivism) evaluations. The most frequent types of assessment are for risk of violence, inappropriate sexual behavior, and criminal recidivism. In some cases, the forensic psychiatrist subcontracts psychological testing; in other cases, a psychologist may conduct psychological testing independently or as part of a hospital team. 147, p 80). First, forensic examiners should always maintain a humane and respectful approach to evaluees. Because the accuracy of the information received enhances the validity of the psychiatrist's conclusions, Heilbrun et al.24 likened the forensic psychiatrist to an investigative journalist, recommending that third-party information be elicited from a variety of sources. /Info 182 0 R For example, if the forensic psychiatrist's opinion depends on a hypothesis that the evaluee has undiagnosed myxedema, it is advisable to seek some comment or confirmation by an independent endocrinologist who is knowledgeable in thyroid disease. Current occupational functioning should be reviewed when assessing a person's claimed emotional damage or disability. However, the biases of various reporters also should be considered.16, Collateral information for the expert's review may include written records, recordings, and collateral interviews. It has been argued that the Psychopathy Checklist, Revised (PCL-R),120 has limited generalizability cross-culturally. In some jurisdictions (such as Canada), mental health experts commonly address deterrence in presentencing evaluations. The expert may modify the opinion should relevant additional information become available later. If a private office is the only available location, the presence of family members and staff can be useful in preventing or defusing violence. Both recent and long-term histories of the individual, including their prior level of functioning and usual behavior, are helpful in understanding the context of the situation. >> Finally, for safety reasons, careful preparation before the interview can be helpful in case of unpredictable behavior in a psychotic evaluee. The limits of confidentiality are determined, in part, by which of the legal participants in the matter has retained the psychiatrist, with different warnings being appropriate, depending on whether the psychiatrist is working for the defense, the prosecution, or the court.47 Specifically, the defense expert can inform the evaluee that, if the assessment is not going to be helpful to the case, the attorney may be able to keep it confidential as part of attorney work product. Distress may manifest in culturally specific ways in individuals with different life histories.179, Religion, culture, and race may affect a psychiatrist's worldview, causing bias (or the appearance of bias). In addition, it may be possible to obtain extensive data such as personal notes and diaries, computer files, and video recordings or undercover investigational reports. When application of these exceptions and rights becomes complicated, states may appoint a guardian ad litem to help the court weigh the various factors and consider the various interests in a case. In certain circumstances, the psychiatrist may wish to have a third party present to ensure safety or to have an objective observer in case of a litigious or difficult evaluee. /BleedBox [ 9 9 612 792 ] >> See also American Academy of Psychiatry and the Law, AAPL Practice Guideline for the Forensic Psychiatric Evaluation of Competence to Stand Trial (hereafter "AAPL"), Journal of American Academy of Psychiatry and the Law Online, Mossman et al, December . The warning should include informing the source of how the information may be used. Awareness of inappropriate emotional responses to the case may well lead the expert to self-examination of those reactions.7,67 The feelings and attitudes of the evaluator prompted by a case can be described as a forensic example of countertransference. The evaluator's degree of suspicion about ID during the assessment can increase the likelihood that ID will become a relevant factor. The use of FAIs is not required, and no FAI is universally used in any type of forensic assessment. A formal job description obtained from the employer can be used to define essential tasks. The psychiatric history is an important element in all forensic assessments. This Practice Resource is a revision of the 2008 AAPL Practice Guideline for the Forensic Evaluation of Psychiatric Disability.) Similarly, an evaluee who had been disabled by a work-related accident might have PTSD as a result of a second accident, and the inter-relationships between the two events might be of overriding forensic importance. 18, p 44) to allow their voices and concerns to be aired in the assessment process. /FontName /NILMNI+GillSans-Bold How to write a psychiatric report for litigation following a personal This Practice Guideline should not be construed as dictating the standard for this type of evaluation. Epub 2015 Jun 8. 0=4[Uhs#MBI\z"u)&n Common cases in which psychic harm may be at issue include allegations of disability due to medical intervention, discrimination or harassment in employment, or PTSD or related illness due to a traumatic event.136 In cases in which intentional or negligent infliction of emotional distress is alleged, the forensic psychiatrist is typically asked to assess and describe the evaluee's level of disability, which can help the court evaluate the level of damages.45 Gerbasi137 recommends paying special attention to somatization, pre-existing conditions, diagnosable personality disorders, and malingering (see Section 10.5, Malingering and Dissimulation). /Subtype /Type1C Many of the subjects given brief treatment here are covered in more depth in published texts and journal articles. The expert can also assist the court by assessing the risk of reoffending, violence, or suicide.6 Depending on the jurisdiction (e.g., federal versus state), there may be a need to contact a referral source, such as probation, to clarify the questions the court may want to have answered. These reports can be critical to forensic assessment because they provide the factual allegations that serve as the basis for criminal charges. AAPL Practice Guideline for the Forensic Assessment. Any discrepancies in the evaluee's account of circumstances may be clarified through collateral records or statements. The evaluator may have to obtain full and informed legal consent from a guardian or obtain a judicial order. Although these opinions can be problematic and are not generally recommended, if a preliminary opinion is given, its limitations should be explained and the need for further information described. Forensic assessment may be possible only if the client can communicate with formal American Sign Language. A measure that reveals repeated failures on very simple items is insufficient, as malingering evaluees may successfully mimic mild to moderate impairment, which is enough to achieve their objective. 0000023021 00000 n In addition to warnings concerning the lack of confidentiality routinely made in forensic assessments, an evaluator who is recording an interview should inform the evaluee in advance that the interview will be recorded and that the recording becomes a legal document that may be introduced in court if the evaluator is used as an expert. The evaluator should consider that evaluees detained in a correctional facility may not have undergone a detailed mental status examination, and it is not unusual for a forensic assessment to reveal genuine symptoms and signs that have not been identified in that setting. Furthermore, some new instruments being used in the field, such as those for risk assessment, do not require psychological training, per se, for their administration or interpretation, but their use may nonetheless require specific training. In such cases, the primary evaluator may ask the ancillary professional to supply further information or to reinterview a source, or the primary evaluator may follow up by reviewing data or reinterviewing sources. Other medical factors that may be relevant to the forensic assessment include intellectual or developmental disability, narcolepsy, and sleep apnea. AAPL Practice Guideline for forensic psychiatric evaluation of defendants raising the insanity defense J Am Acad Psychiatry Law. Opinions vary regarding whether an evaluee should be warned that malingering on his part will be assessed. A careful review of the evaluee's medical records can be especially helpful. Competent assessment of an evaluee with ID requires the evaluator to adapt the approach to account for the unique characteristics of the evaluee.156. If the psychiatrist works with a team, other members of the team may summarize large volumes of information, although the psychiatrist signing the report accepts responsibility for its content.