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Clinicians can play an integral role in the ultimate determination of defendants’ criminal responsibility, given that information gleaned from mental state at the time of the offense (MSO) evaluations influence judges and jurors’ decision-making about a particular case. Such evaluations are particularly complicated due to their retrospective nature, lack of a standardized assessment approach, and variability in criminal responsibility statutes across jurisdictions and time. Yet several legal, clinical, and contextual factors appear to impact clinicians’ decision-making when tasked with these evaluations. In this chapter, we examine the existing literature regarding MSO evaluation referrals, including combined evaluations, to help inform practitioners’ expectations. Next, we review critical components of an MSO evaluation and identify challenges for clinical decision-making. Then we discuss forensic report writing and testifying, as informed by the literature regarding best practices. Lastly, we suggest how field reliability of mental state evaluations might improve through research and policy.
Despite the increasing evidence base and focus given to Early Intervention in Psychosis (EIP) services, qualitative literature remains sparse, particularly in relation to the ‘At Risk Mental State’ (ARMS) group. Although research has looked to service user experience within EIP, data have not been collated to understand valued aspects of treatment across both EIP groups: first episode psychosis (FEP) and ARMS, particularly regarding cognitive behavioural therapy (CBT).
Aims:
To conduct a systematic review of qualitative literature to examine service user perspectives on support provided in EIP treatment with a focus on CBT.
Method:
This was a thematic synthesis of qualitative studies. Nine studies were included in the analysis identified through a systematic database search and citation tracking. Studies were critically appraised using the critical appraisal skills programme tool.
Results:
Nine studies were identified for inclusion. Six analytical themes and 20 descriptive categories were identified.
Conclusions:
User perspectives confirm previous findings highlighting importance of therapeutic relationships for treatment success. Normalisation, learning and understanding were valued across both groups, which increased coping, and can be facilitated throughout the EIP journey. Harnessing the support of those involved in users’ care and understanding these relationships further enhances interventions utilised. Understanding the stage the individual is at regarding their experiences is essential in relation to targeting support. Transdiagnostic aspects of CBT were valued across both groups. ARMS referred to more specific strategies and there were some differences regarding coping styles and flexibility preferences; however, this may be due to group differences in problem trajectory and care provision.
A 10% prevalence of intracranial aneurysms in patients with coarctation of the aorta has been described in a few studies. Our objective is to describe the rate of intracranial aneurysm detection in patients with coarctation of the aorta in the current era. We hypothesise that, with earlier detection and coarctation of the aorta intervention, the rate of intracranial aneurysm is lower than previously reported and screening imaging may only be warranted in older patients or patients with certain risk factors.
Methods:
This is a retrospective study of 102 patients aged 13 years and older with coarctation who underwent brain computed tomography angiography, magnetic resonance imaging (MRI), or magnetic resonance angiography between January, 2000 and February, 2018.
Results:
The median age of coarctation repair was 4.4 months (2 days–47 years) and the initial repair was primarily surgical (90.2%). There were 11 former smokers, 4 current smokers, and 13 patients with ongoing hypertension. Imaging modalities included computed tomography angiography (13.7%), MRI (41.2%), and magnetic resonance angiography (46.1%), performed at a median age of 33.3 years, 22.4 years, and 25 years, respectively. There were 42 studies performed for screening, 48 studies performed for neurologic symptoms, and 12 studies performed for both screening and symptoms. There were no intracranial aneurysms detected in this study.
Conclusions:
These results suggest that the rate of intracranial aneurysms may be lower than previously reported and larger studies should explore the risk of intracranial aneurysms in coarctation of the aorta in the current era.
Survivors of mass casualty incidents are vulnerable to both physical and psychological injuries. Hospitals need to triage the walking wounded victims, their loved ones, and witnesses for symptoms of emotional distress to ensure that those who are traumatized benefit from proactive psychological treatment. Hospitals must also manage the influx of searching family and friends, and be able to reunite them with their loved ones, to reduce chaos and prevent hospital skipping.
Aim:
To analyze previous research on institutional psychosocial disaster response, what has or has not worked, and lessons learned in order to develop evidence-based future planning suggestions.
Methods:
A literature search was conducted on the following electronic databases: (Medline 2007 to July 2018), (Embase 2007 to July 2018), (PsycInfo 2007 to July 2018). A combination of subject headings and free text keywords were used to perform the searches. After removing duplicates, abstracts were screened independently by two reviewers for the following inclusion criteria: 1) crisis intervention (in a disaster situation), 2) mention of psychosocial response or lack thereof and lessons learned, 3)relevant outcomes, 4) OECD countries, and 5) journal articles published 2007–Present. Review articles were excluded. Primary and secondary reviewers are in the process of discussing discrepancies. Data extraction will be conducted from all articles that meet the inclusion criteria. Key themes to be analyzed include psychological casualties, searching family and friends, and family reunification plans.
Results:
The initial search yielded 6,267 results. 5,294 articles remained after duplicates were removed. Of the 4,890 reviewed thus far, 269 articles met inclusion criteria.
Discussion:
Although a wealth of existing literature notes the need for an effective psychosocial response in mass trauma and disaster situations, no prior study has analyzed the efficacy of such interventions or laid out an evidence-based plan. This study will fill this much-needed gap in the literature.