Hyperparathyroidism and psychosis: possible prelude to murder

The authors present a case of a middle aged attorney who suffered from hyperparathyroidism and a psychotic disorder. It is possible that the hyperparathyroidism may have precipitated an acute psychotic delusional rage leading to an attempted mass murder. They discuss the relationship between hyperparathyroidism and neuropsychiatric symptoms in consideration of available research.     

Claims of amnesia for criminal offenses: psychopathology, substance abuse, and malingering

The forensic psychiatric examiner often encounters defendants who deny memory for their offense. Past research proposes a variety of factors to account for offense amnesia. To date there have been few systematic studies of offense amnesia in relation to psychiatric diagnosis, either alone or in combination with other known factors such as substance use and malingering. We studied 53 pretrial felony defendants who had been referred for psychiatric examination; 40% claimed amnesia for their offense. Examinees with psychotic disorders in general, and schizophrenia in particular, were relatively less likely to claim amnesia than were examinees with other diagnoses. Substance use at the time of the offense and associated substance use disorder diagnoses were positively associated with offense amnesia. Malingering diagnosed by general clinical criteria was a poor predictor of amnesia claims. These data suggests that two prominent reasons for referral for forensic psychiatric evaluation include the presence of psychotic symptoms and claims of amnesia for the offense.     

90例医疗纠纷尸检分析

目的分析、讨论医疗纠纷中法医病理学尸体解剖的重要性。方法收集温州医学院法医学系2001—2008年涉及医疗纠纷尸体解剖案例90例,按照死者年龄、性别、死亡原因及临床诊断和法医病理诊断等要素进行分类整理和分析。结果死者年龄从新生儿至72岁,男女比例为1∶1,医院级别以县级医院较多（30例,33.33%）,临床诊断与法医病理死因诊断符合率为33.33%。结论尸体解剖对涉及死亡的医疗纠纷的正确处理和防范有重要作用。     

Minimizing mistakes in clinical diagnosis.

It would be quite reasonable for us to expect the progress made in diagnostic technology to be accompanied by a parallel improvement in diagnostic accuracy. In reality, however, the frequency of misdiagnoses remains the same, despite the fast progress which has been made by medical technology in the last 30 years. Autopsy is the best source of information on diagnostic accuracy. According to one hypothesis, an increase in the number of autopsies performed and the follow-up on them could reduce the number of diagnostic mistakes. In recent times, however, the number of autopsies in comparison with the registered number of deaths has been declining steeply. We studied the autopsy reports for 1997, kept at the archive of the Institute for Forensic Medicine. We only took into account the deaths which occurred within 24 h of admittance to the emergency wards of the Ljubljana University Hospital, including those patients who died subsequently as a consequence of accident or injury. We also included cases of sudden deaths which occurred during operating or within 24 h after it. Following selection, we analyzed 444 out of the total of 921 autopsy reports, for each of which we carried out a comparison between the postmortem diagnosis and the clinical diagnosis, contained in the medical report on the death and the causes of death, which is modeled on WHO recommendations, i.e., the International Classification of Diseases (ICD), and in the medical documents, if any were submitted. Data are entered in these by using the ABC system where: A) direct cause of death, B) are circumstances that influenced the occurrence of death, and C) is original cause of death. The findings were then organized into five groups, depending on the degree to which the clinical diagnosis agreed with the postmortem diagnosis. The first group is comprised of the cases where the clinical and postmortem diagnoses agree completely; the second group is comprised of the cases of partial disagreement on the direct cause of death; the third group is comprised of the cases of disagreement on the original disease; the fourth group, of complete disagreement between the clinical and postmortem diagnoses. The fifth group is comprised of those cases where, under the ABC standards on the classification of diseases, injuries and causes of deaths as specified by the WHO, the documentation was incomplete. A complete agreement between the diagnoses was established in 48.87% of cases; partial disagreement in 22.74%; and total disagreement in 13.5%. 9.68% of cases were classified as falling into group 5. For the three diseases that are among the most common causes of death, we established the percentage of agreement, the percentage of overdiagnosis and the percentage of underdiagnosis. The most frequently underdiagnosed disease (in 61% of cases) was pulmonary thromboembolia; in 15% a thromboembolia was confirmed in autopsy. In 24%, a myocardial infarction was not diagnosed clinically and in 60% the clinical diagnosis of a myocardial infarction was confirmed in autopsy. In 33% a heart failure was not diagnosed during the clinical stages but only in autopsy, in 66% the clinical diagnosis of a heart failure was confirmed in autopsy.     

Legal Outcomes of Suspected Maltreatment Cases Evaluated by a Child Abuse Pediatrician as Part of a Multidisciplinary Team Investigation

Child abuse pediatricians often carry the stigma that their sole role is to diagnose maltreatment. In reality, child abuse pediatricians use their clinical experience and current evidence-based medicine to make the best medical diagnoses for the children they evaluate. To better understand the legal conclusion of suspected maltreatment cases with medical examinations, this study sought to: (i) evaluate the percentage of children seen for suspected maltreatment that led to a clinical diagnosis of maltreatment, (ii) determine the number and type of criminal charges associated, and (iii) analyze the legal outcomes of cases as they proceeded through the judicial system. This study retrospectively reviewed the legal outcomes of 1698 children medically evaluated in 2013–2014 as part of an investigation by a multidisciplinary team at a children’s advocacy center in a mid-sized city in Oklahoma. Data were collected from electronic medical records, the district attorney’s office, and a public court docket. Of the original cohort, 477 (28.09%) children yielded a medical diagnosis of at least one type of maltreatment. Further analysis yielded 115 unique court cases involving 138 defendants and 151 children. A total of 286 charges were filed resulting in 190 convictions. While maltreatment allegations yield a high number of children that must be evaluated, a comprehensive medical evaluation helps determine which cases do not have sufficient medical findings for a diagnosis of maltreatment. The findings in this study indicate that a majority of suspected maltreatment cases seen by child abuse pediatricians did not result in criminal court outcomes.     

论职业病诊断的医学循证与法律推定

不同于一般临床疾病的诊断,职业病诊断是归因诊断,兼具医学性、法律性的特点。《职业病防治法》第四十六条前两款对职业病诊断作出了原则性规定,其中第二款的法律推定体现了职业病诊断的立法价值取向。然而,职业病诊断标准并未高度契合法律推定条款,法律推定操作性欠佳,诊断实务中不同专家对这两款的各自作用和相互关系认识不一,法律推定的适用与否直接影响诊断结论和法律价值的个案实现。对职业病诊断中该两款的协调及法律推定的操作进行论述,以供参考。     

Settlement Disputes: Evidence from a Legal Practice Perspective

This paper explores the agency relationship between a lawyer and a client in the context of deciding whether to settle a case. The impact of alternative fee arrangements on settlement disputes is empirically assessed in a discrete dependent variable econometric model utilizing survey data from lawyers in British Columbia. In contrast to the previous research based on traditional single-task principal-agent models, a broader multitask perspective of a lawyer's practice is explored. More frequent settlement disputes are observed where the handling of disbursements is one-sided, and among lawyers who advertise, use lump sum billing and pursue jury trials and punitive damages. Disputes are less frequent among lawyers who employ percentage contingency fees and hourly rate contracts with a bonus for successful results. Disputes are also less frequent among lawyers in larger firms. There is also evidence that legal fee regulation and ex post judicial review of legal fees in British Columbia have affected the frequency of settlement disputes.     

IN SEARCH OF A LINKAGE

Previous research has produced conflicting findings concerning the relationship between police evaluation by citizens and unreported crime rate. Data for thirteen large American cities indicate a weak positive relationship between the two variables. Strong negative relationships are evident between unreported crime rate and variables measuring police systems activities and demographic characteristics. Cities with the highest levels of police expenditures and manpower have the lowest levels of unreported crime, as do cities with high percentages of nonwhites and dense populations. Further analysis reveals that controlling for percentage of nonwhites and police manpower severely attenuates the original correlation between unreported crime rate and police evaluation. We conclude that future research should endeavor to explain the linkage between police systems activities and unreported crime.     

Insanity, methamphetamine and psychiatric expertise in New Zealand courtrooms

The use of methamphetamine in New Zealand has increased significantly over the last decade. Due to the potential of methamphetamine to induce, exacerbate and precipitate psychotic symptoms, this drug has also taken centre stage in several criminal trials considering the sanity of defendants. Highly publicised and often involving contested expert evidence, these criminal trials have illustrated the limits of using psychiatric expertise to answer legal questions. This article considers the implications of such cases in light of material from a qualitative study that aimed to generate insights into the difficulties forensic psychiatrists and their instructing lawyers face when providing expert evidence on the relationship between methamphetamine, psychosis and insanity. It reports material from 31 in-depth interviews with lawyers and forensic psychiatrists and observation of one criminal trial that considered the relationship between methamphetamine and legal insanity. The findings are correlated with the clinical and medico-legal literature on the topic and subjected to scrutiny through the lens of "sanism". The article concludes that the continued use of forensic psychiatry to meet the legal objectives of insanity, where methamphetamine is involved, has the potential to reinforce sanist attitudes and practices.     

Legal outcomes of all suspected neonaticides in Finland 1980-2000

This nationwide study examined legal outcomes and possible psychiatric diagnoses of suspected cases of neonaticide. Neonaticide is commonly defined as the killing of a newborn on the day of its birth, and is considered to have not only a low prevalence but also a high level of concealed criminality. This hidden nature guided us to find out what the final legal outcomes of suspected neonaticide were. It was a comprehensive, retrospective, register-based study of all 44 cases of suspected neonaticide that occurred 1980-2000 as recorded by Statistics Finland. The 44 cases were ascribed to 40 suspects, three of whom died themselves during the offence. Twelve cases (27%) were eventually prosecuted and the accused convicted of neonaticide. Their mean sentence was 617 days (SD 216, range 300-1095 days). Fourteen offenders (35% of offenders) underwent a forensic psychiatric examination, out of which four (29%) were diagnosed with a psychotic disorder and 10 (71%) with a personality disorder. Six of the 14 women were not sentenced as criminally irresponsible and three of them were committed to involuntary hospital care. Nine cases (20% of cases) were still unsolved, and in eight (18%) cases the offence title had changed into something other than neonaticide. We concluded that since only 41% of suspected neonaticides completed the court process as neonaticides, the previous results from studies on neonaticide may present a subgroup of offenders, not the whole picture. Therefore, further discussion and research is needed to elucidate this perplexing, sad, and utterly redundant offence in modern society, to prevent it, and develop treatment programs for the offenders.     

The role of shame, anger, and affect regulation in men's perpetration of psychological abuse in dating relationships

This study determines the relationships between shame, anger, and men's perpetration of psychological abuse in dating relationships. The authors hypothesize the connection between shame proneness and men's use of psychological abuse with a dating partner, with anger's mediating in this relationship. In addition, the authors hypothesize that affect regulation would moderate the relationship between anger and men's use of psychological abuse. Results indicate that shame proneness and use of psychological abuse are significantly related and that anger mediates the relationship. However, affect regulation does not moderate the effects of anger on men's use of psychological abuse. These findings are consistent with theoretical conceptualizations of shame and have implications for intervention and treatment programs for perpetrators of psychological abuse in dating relationships.     

上海文化立法规划和文化法律思想研究

中华人民共和国成立以来,虽然在调整人们的社会文化关系和文化事业管理的一些重要方面,初步做到了有法可依、有章可循,但是,也必须看到,这只是很初步的;长期以来,国家的文化法制建设明显滞后,立法数量偏少,立法层次偏低,是个突出的问题。这离“依法治国”、“实现社会主义法治国家”的基本方略和要求还有一定的距离。离依法有效地、公平地、稳定地促进和调控文化事业和一切文化活动的改革开放要求,还是有相当差距的。就上海乃至全国而言,加快文化立法进程,以逐步形成较为完备的文化法规体系,是十分必要的。在此进程中还必须明确有关的文化法律思想,厘清有关文化发展与文化法制建设中的若干基本关系。     

香港特别行政区基本法解读：中央与香港关系法治化之实现

在宪法话语下，香港特别行政区基本法是中国第一部实现中央与其组成部分——香港关系法治化的法律文件。它规定了中央与香港各自专有职权、共有职权及双方职权冲突解决机制，使二者关系走上法治化轨道。中央与香港关系法治化的实现，是由香港特殊的历史地位、香港特别行政区基本法制定方式及香港法治传统等因素决定的。在二者关系法治化进程中还有一些地方需要追一步完善，例如，特别行政区行政长官与中央关系、权力冲突协调机制及有关组织机构的性质地位等。香港特别行政区基本法确立的中央与香港关系法治化模式，对整个国家范围内中央与地方关系法治化有重要启示意义。     

Criminal offense, psychiatric diagnosis, and psycholegal opinion: an analysis of 894 pretrial referrals

This article presents the results of a study of 894 criminal defendants referred by Virginia courts for evaluation of competency to stand trial or criminal responsibility. All evaluations were conducted on an outpatient basis by mental health professionals who had received specialized training in forensic evaluation. Findings as to the referral questions posed, the criminal offenses charged, and the clinical diagnoses and psycholegal opinions offered by the evaluators are described. Statistical analyses demonstrate significant relationships between both diagnosis and criminal charge and the psycholegal opinion rendered.     

我国预算法修订的规范分析

追求和实现预算民主是我国预算法修订的目标之一。预算法律关系是公共预算关系的抽象和拟制,是立法者运用立法技术制定法律规范的基础和指引,在预算立法与实践之间起着承启的作用。修订预算法应加强预算法律主体的开放性和制衡性,规范和完善不同的预算法律行为及其法权配置,并使预算法律责任具有科学性和可操作性。对预算法律文本中蕴含的各类法律关系进行规范分析,旨在通过对预算法律所预设的逻辑秩序进行阐释和解析,进而说明和论证预算法律规范设定的主体、行为和责任等逻辑秩序与预算实践秩序间的关系。     

Psychiatric diagnosis as a risk marker for victimization in a national sample of children

Research examining childhood abuse has shown an association between victimization and psychiatric diagnoses (e.g., posttraumatic stress disorder, depression). Historically, psychiatric diagnoses have been emphasized as a consequence of victimization, with less research examining if it also functions as a risk factor for further victimization, perhaps making diagnoses a general victimization risk marker. In addition, much of this research has emphasized particular types of victimization such as childhood physical or sexual abuse. Researchers have given less attention to other forms of victimization (e.g., peer victimization, witnessed violence) or a diverse victimization history. Using the Juvenile Victimization Questionnaire (JVQ) we surveyed parents and children between the ages of 2 and 17 using a random digit dial (RDD) methodology. We examined the relationship between a number of different forms of victimization (termed poly-victimization ) in the preceding year and parent-reported lifetime psychiatric diagnosis. Results show that children with a psychiatric diagnosis have significantly higher rates of victimization than children without a psychiatric diagnosis. In addition, using logistic regression models, we find that psychiatric diagnosis was associated with increased risk for poly-victimization, conventional crime victimization, maltreatment, peer or sibling victimization, and witnessing violence, but not sexual abuse. The results highlight the need to consider psychiatric diagnoses as a risk marker for past and possible future victimization. In addition, the importance of obtaining a comprehensive and more diverse victimization history when working with children is highlighted.     

Fiery tongues and mystical motivations: glossolalia in a forensic population is associated with mania and sexual/religious delusions

Comparisons are made between a nonrandom sample of 18 glossolalists and 130 non-glossolalists admitted to a maximum-security forensic hospital. The glossolalic mentally disordered offender exhibited a predominance of diagnoses in the manic spectrum, and was typically psychotic. The delusions, hallucinations, and crimes were predominately of a religious and sexual nature. Glossolalist perpetrators tended to be female. We review the extant research on glossolalia in both normal and clinical samples. and integrate our findings, the first study of glossolalia in a forensic setting.     

Prevalence and screening of mental disorders in short-term correctional facilities

A majority of people incarcerated in correctional facilities have been affected by mental problems at least once in their lifetime. Among them, 12 to 25% suffer from severe and persistent mental disorders at the time of admission. Certain “profiles” are more likely to be detected than others. This is why the main objectives of this research are to establish, in both male and female offenders admitted in short-term detention facilities, the rate of those who have received medical diagnoses of mental disorders, the rate of screening for “mental health problems” at admission and the psychiatric diagnoses (last five years) most strongly associated with a positive screening. Using computerized medical and prison files, it can be established that 61% of the 671 offenders sent to a short-term correctional facility received, during 2002–2007, at least one diagnosis for mental disorder. A total of 227 subjects (33.8%) obtained a positive score to the indicator of mental health problem.” In the case of men, correctional services workers identified as mental health problems: psychotic disorders, adjustment reactions, «neurotic»/anxiety disorders, being coupled to drug dependence. Positively detected women tend to exhibit problems of anxiety, personality disorder and substance related disorders. This study highlights, the difficulties faced by correctional services workers in detecting recent depressive disorders both in men and women offenders and also difficulties to detect recent affective psychoses.     

Civil Cases and Society: Process and Order in the Civil Justice System

It is not an exaggeration to say that we live in an era preoccupied with the problems and challenges of obtaining justice in civil cases. Concerns expressed about the civil justice system range from warnings that civil court dockets are clogged by disputants too litigious for their own good to complaints that the legal system is used too rarely in civil cases.
The authors approach their analysis with a sense that this subject area is in need of more and better theory. It is an unfortunate fact that discussions of civil justice—and suggestions for reform—have been marked by contradiction and confusion and have been engrossed with small matters that tend to obscure from view the system as a whole.
The first part of this essay focuses on what the civil justice system is and does. It presents a five-stage model of civil case processing and examines relationships between this model and the criminal justice system. The second part of the essay considers this model in a broader context. Here the authors examine two paradigms of civil case processing and their implications for the implementation of legal norms and the pursuit of justice in society.