Comamonas testosteroni meningitis in a homeless man

We report a case of meningitis caused by Comamonas testosteroni in a 54-year-old, alcoholic, homeless man. He, as a pedestrian, was struck by a car and suffered multiple fractures of the facial bones including the left frontal sinus. Over the course of 2-week hospitalization, he was clinically diagnosed with multiple cerebral and cerebellar infarcts resulting in altered mental status. He was pronounced dead 15 days after the injury. At the time of autopsy, diffuse purulent meningitis was found on gross examination. A swab culture of the brain surface was positive for C. Testosteroni, a saprophytic organism commonly found in soil and water. This is the first reported case of fatal meningitis caused by this micro-organism.     

Unsuspected central nervous system gummas in a case of "cerebral infarct" associated with cocaine use

A 54-year-old African-American male was hospitalized with a left "cerebrovascular accident," altered mental status, agitation, rhabdomyolysis, and hypernatremia. Laboratory tests found cocaine in his system and a positive RPR (rapid plasmin reagin test). A CAT (computed axial tomography) scan without contrast taken 8 days prior to his death showed a left middle cerebral artery infarct, with edema and mass effect, and a 1-cm midline shift to the right. He underwent symptomatic treatment, eventually suffered cardiopulmonary arrest and multiorgan failure, and expired 8 days after admission. The left cerebral lesion diagnosed clinically as a cerebral infarct was actually determined to be a syphilitic gumma on postmortem neuropathologic examination. Neurosyphilis, although rare, should be considered in the differential diagnosis of space-occupying lesions in the brain because cases of syphilis continue to occur both sporadically and as an opportunistic infection associated with acquired immunodeficiency syndrome (AIDS) and because neurosyphilis is treatable.     

Prepartum Psychosis and Neonaticide: Rare Case Study and Forensic‐Psychiatric Synthesis of Literature

Peripartum psychosis is a rare but serious psychiatric disorder characterized by the presence of a mood episode with psychotic features. Although controversy surrounds the nosological status of peripartum mental disorders, these conditions continue to be of exceptional interest to the medical and forensic mental health communities. The aim of this study was to report a rare case of prepartum psychosis which escalated to the endpoint of neonaticide and summarize literature on peripartum mental disorders and infanticide. A 30‐year‐old mother murdered her newborn with the spike of her serum delivery system and planned to commit suicide while in hospital after hallucinating due to an acute puerperal psychotic disorder with a prepartum onset and postpartum deterioration. Her disorder was not managed until neonaticide. Throughout this paper, the significance of a multidisciplinary approach for the optimal management of these incidents is highlighted and diagnostic as well as therapeutic issues are addressed.     

Sudden and unexpected death from pituitary tumor apoplexy

Pituitary tumor apoplexy refers to a clinical syndrome precipitated by the expansion of a pituitary adenoma by hemorrhage or infarction. Individuals may present with myriad signs, including sudden onset of severe headache, visual changes, altered mental status, cranial nerve palsies, and hormonal dysfunction. This disorder constitutes a medical emergency and warrants an expedited evaluation, diagnosis, and treatment to prevent the potential sequelae of permanent visual loss, endocrine abnormalities, or death. We report a case of sudden death from undiagnosed pituitary tumor apoplexy. The decedent was evaluated by medical personnel on three occasions in the week prior to her death for severe headache, nausea, vomiting, and photophobia. Postmortem examination demonstrated a hemorrhagic infarction of a pituitary adenoma with necrosis and expansion out of the sella turcica. The recognition of and treatment for a patient with pituitary tumor apoplexy requires a rapid multidisciplinary effort. Failure of prompt diagnosis may be fatal and require a medico-legal death investigation for sudden and unexpected death.     

Mental health, gender, and drug court completion

Drug-involved offenders report high rates of mental health problems that can negatively impact criminal justice outcomes. Yet, relatively little attention has been given to the mental health issues of drug court offenders. Therefore, this study examined 449 participants in a Delaware drug court and investigated relationships between mental health, gender, and program completion. Bivariate results indicated that gender was related to both mental health status and completion status. Multivariate findings revealed that two indicators of mental health, depression and being prescribed drugs for a psychological or emotional problem, were significant predictors of drug court completion. Policy implications include assessing the mental health status of all drug court participants at program entry so that services can be provided which aim to improve offender health and increase the likelihood of successful program outcomes. Drug courts must better meet the needs of participants with co-occurring disorders if they are to remain an effective and viable criminal justice intervention. This research was supported by grant RO1 DA12424 “Drug Court Offenders in Outpatient Treatment,” by the National Institute on Drug Abuse.     

Heterosexual intimate partner homicide: review of ten years of clinical experience

Most of the literature on intimate partner homicide addresses violence between the two partners, spousal abuse, and family violence. There is less focus on the relationship of mental illness, intellectual functioning, and drug and alcohol abuse to these homicides. We investigated this type of homicide in a collection of forensic cases seen by the first author over a period of 10 years. Twenty-eight patients who underwent forensic psychiatric evaluation for heterosexual intimate partner homicide from August 1993 to June 2003 were studied using a retrospective case review methodology. We found that firearms were used as the method of killing more often by females than by males. We also compared method of killing with substance abuse and intoxication at the time of the homicide. Educational status indicates that this group of accused perpetrators is functioning at higher intellectual levels compared with a previously studied sample of filicides. We also found significant presence of serious mental illness in our sample of accused perpetrators of heterosexual intimate partner homicide.     

The relationship between childhood sexual abuse and adult mental health among undergraduates: victim gender doesn't matter

A large body of research has documented the harmful effects of childhood sexual abuse (CSA) on adult mental health among females, but less work has examined this issue among males. This study examined whether gender moderated the relationship between CSA and adult mental health among a mixed-gender sample of 406 undergraduates. A Pearson chi-square test indicated that a significantly greater proportion of females (41.6%) than males (30.7%) reported a history of CSA. ANCOVAs tested whether gender, CSA status, and their interaction were related to adult mental health symptomatology as measured by Brief Symptom Inventory gender-normed t scores. Participants with a history of CSA reported significantly higher levels of global mental health problems, hostility, paranoid ideation, and psychoticism. The gender by CSA status interaction was not significant for any scale, indicating that the harmful effects of CSA on adult mental health did not vary by gender.     

运用神经行为测试系统评价酒后行为功能的可行性研究

目的研究运用神经行为测试系统评价酒后行为功能的可行性。方法采用汉化第三版计算机化神经行为评价系统(NES-C3),通过自身对照的方式,对49名饮酒者进行神经行为功能的测试,并与步行回转试验进行比较。结果心算、视觉保留、线条判断和数字筛选均在酒后0.5￣2.5h的时间点上能力指数有所下降,视简单反应时能力指数下降则延续至酒后5.5h;步行回转在酒后0.5￣2.5h间有阳性案例。血中酒精质量浓度在0.50mg/mL以上,视觉保留、线条判断及视简单反应时的能力指数有明显下降;血中酒精质量浓度在0.80mg/mL以上,心算和数字筛选的能力指数有明显下降。步行回转实验的阳性人数在血中酒精质量浓度0.50mg/mL以上有明显增加。结论计算机化神经行为评价系统作为一个定量指标,可反应酒精质量浓度与神经行为功能的关系,且比步行回转试验更客观、更灵敏。     

Developmental Impacts of Child Abuse and Neglect Related to Adult Mental Health, Substance Use, and Physical Health

This study examined the association between officially recorded child abuse and neglect and adult mental health, substance use, and physical health outcomes. Data are from a longitudinal study of more than 30 years in which individuals were interviewed most recently in their mid—30s. Analyses consisted of group comparisons using chi-square tests for categorical variables and independent samples t-tests for continuous measures. Logistic and linear regressions controlled for gender and childhood SES, adult age, marital status, and education. Adults maltreated in childhood reported more symptoms of adult depression, anxiety, and more impairment due to mental and physical health problems. A higher percentage of those with maltreatment histories reported lifetime alcohol problems and appear at greater risk for substance abuse. Most findings of these bivariate analyses remained significant after accounting for gender and childhood socioeconomic status. Somewhat fewer significant results were observed after controlling for adult age, marital status, and education.     

Attitudes toward physician-assisted suicide: Effects of physician background,patient prognosis and patient mental health status

Abstract

The purpose of this study was to investigate views toward physician-assisted suicide (PAS) as patient illness (terminal, not terminal), patient mental health (depressed, not depressed) and physician background (preoccupied, not preoccupied with death) are varied. Participants (N = 211) read a newspaper article and trial summary involving a PAS then gave their impressions of the patient, physician and PAS. Patient mental health did not affect decisions, but the preoccupied physician's testimony was seen as less believable (intent was seen as patient death, not an end of pain and suffering), and he was more likely to be seen as guilty than the non-preoccupied physician (reflected by both verdict and guilt level ratings). The terminal patient was seen as suffering more, wanting suicide more, and making a more rational decision to die than the non-terminal patient. Results are discussed in light of recent legal activity involving PAS.     

Brief mental health screening of prison entrants: psychiatric history versus symptom screening for the prediction of in-prison outcomes

While prisoners are known to suffer very high rates of mental illness, evidence is often lacking to inform the development of effective approaches to prison mental health service provision, including the approach to mental health screening. In addition, research to date has been dominated by prevalence studies and little is known about the mental health needs of prisoners over time. A random sample of prison entrants was recruited from a large remand and reception prison in New South Wales, Australia (n = 707) for the completion of a brief health survey. A second survey was completed during the subsequent six months (n = 317) in order to examine the effect of timing of assessment on mental health status. Those followed up within three months (n = 182) were further included in an analysis of predictive validity comparing the performance at baseline of self-reported history of previous diagnosis versus current symptom screening for psychological distress, in predicting subsequent mental illness. When assessed over six months from prison entry, mental health status was found to vary by timing of assessment. At prison entry, self-reported history of previous diagnosis of a mental health disorder was found to be a better predictor of mental illness over three months than screening for psychological distress.     

POLICE RESPONSE TO DOMESTIC VIOLENCE: SITUATIONS INVOLVING VETERANS EXHIBITING SIGNS OF MENTAL ILLNESS*

Drawing on attribution theory, research on police discretion, and public attitudes toward mental illness, we examine attributional processes in police decision making in response to domestic violence situations involving veterans and nonveterans with signs of mental illness. Using data from experimental vignettes varying veteran status, victim injury, and suspect compliance administered to a sample of 309 police officers, the results indicate that 1) veterans are perceived as less responsible for troublesome behavior but more dangerous than nonveterans, 2) suspects’ veteran status has a significant effect on officers’ preference for mental health treatment versus arrest, and 3) part of the effect of veteran status on officer response is mediated by internal and external attributions for problematic behavior and by perceptions of dangerousness. The study empirically demonstrates countervailing processes in police decision making—recognition of the causes for troublesome behavior and the need for mental health treatment on the one hand and concern for community safety and enforcing the law on the other.     

Posttraumatic stress disorder in murderers

Three case histories of men who suffered posttraumatic stress disorders after committing homicides are presented. These men were relatively young and had chaotic childhoods and minimal criminal histories. Each had killed a woman with whom he had a significant but intensely turbulent emotional relationship. The killings all occurred during altered mental states that were unrelated to the use of drugs or alcohol. The clinical significance and some of the medicolegal implications of this phenomenon are discussed.     

Effects of High‐g Impact on Physical,Electrical, and Optical Characteristics of Light‐Emitting Diodes

Previously, one of the tools available in automotive or aircraft accident analysis was the examination of the indicator bulbs. Currently, indicator bulbs have been largely replaced by light‐emitting diodes (LEDs). Here a series of studies was carried out on impact effects on LEDs to determine whether their properties change after impact, and whether it is related to its working status (lit or unlit). The LEDs were measured before mechanical shock with a series of tests, including current–voltage, current–light, bandwidth, subject to impact ranging from 450 g to 2000 g, and then retested. The tests showed consistent slight but statistically significant increases in forward voltages at a given current after impact, which could be used to estimate the impact. Some LEDS were imaged before and after impact with thermal and X‐ray imaging, but no mechanical changes were seen. It was not possible to determine the LED's working status from these test results.     

Medium‐Chain Acyl‐CoA Dehydrogenase Deficiency in Adulthood: A Potential Diagnosis in a Patient with Mental Status Changes Suspected of Drug Toxicity

Medium‐chain acyl‐CoA dehydrogenase (MCAD) deficiency is a rare but important component of the differential diagnosis for adults with a history of premortem mental status changes and the postmortem finding of hepatic steatosis. This case report describes a 30‐year‐old white man who, following a period of nausea and vomiting, was admitted to the hospital with sudden mental status deterioration followed rapidly by clinical deterioration and death. Treating physicians in this case suspected acute illicit drug toxicity with synthetic cathinones based on social history. Clinicians and medical examiners should be aware that the presentation, signs, and symptoms described may indicate an underlying inborn error of metabolism such as MCAD deficiency and take action accordingly.     

论公安院校的心理健康教育机制

公安院校心理健康教育出现了教育内容不明确,教育重点不清晰,教育体系不健全等困境。为了应对这种现状,首先要明 确公安院校心理健康教育的重点在于培养健康合格社会成员和培养心理素质过硬的警务人员。因此要建立以心理学教师为主,联合 学生管理教师和德育教师成立心理健康教育队伍,开展面、线、点结合,教育与自我教育、帮助与自我帮助相结合的心理教育机制。     

血中乙醇质量浓度与神经行为能力的关系

目的 研究血中乙醇质量浓度与神经行为能力的关系。方法 采用中文第三版计算机化神经行为测试评价系统（NES-C3）,通过自身对照的方式,对233名饮酒者进行神经行为能力的测试。结果 当血中乙醇质量浓度I〉0．157mg／mL时,视简单反应时和数字筛选能力指数有显著性下降;当血中乙醇质量浓度I〉0．204mg／mL时,心算、视觉保留、线条判断能力指数有显著性下降。结论 神经行为能力随着血中乙醇质量浓度的升高而下降,然后随着乙醇的不断代谢,血中乙醇质量浓度的降低,神经行为能力逐渐恢复。     

Mental health in Canada: Are there any risky occupations and industries?

This study examined the role of occupations and industries in explaining differences among workers reporting poorer mental health in the Canadian workforce. It used data coming from a large representative sample of 77,377 workers engaged in 139 occupations and 95 industries. Logistic regression analysis was used to identify differences in the odds of reporting poorer mental health, adjusting for gender, age, education, marital status, and household income. Results identify ten occupations and nine industries at higher risk for workers reporting poorer mental health. The article concludes by highlighting implications for actors and policymakers and by specifying potential targets for intervention.     

Clozapine--a dangerous drug in a clozapine-naïve subject

Clozapine is a uniquely effective antipsychotic, but is very toxic in clozapine-na?ve subjects. A 34-year-old male patient in a mental health facility, who was not prescribed clozapine, took 350 mg clozapine obtained from another patient at night. He was found dead the next morning. The presence of cardiomegaly related to obesity may have increased the risk of suffering an acute cardiac event after ingestion of clozapine. The medication prescribed to the patient was not thought to have contributed to the fatal outcome. Post mortem femoral blood clozapine and norclozapine concentrations were 0.48 and 0.20mg/L, respectively. By way of comparison, audit of 104,127 plasma samples (26,796 patients) assayed for therapeutic drug monitoring purposes 1993-2007, showed plasma clozapine 0.35 mg/L or more in 57.5% samples (8.4% 1mg/L or more). Those involved in the investigation of clozapine-associated deaths need to be aware that that death in an adult may occur after a single 'therapeutic' dose. A diagnosis of fatal clozapine poisoning cannot be made solely on the basis of a post mortem blood clozapine measurement.     

Altered handwriting suggests cognitive impairment and may be relevant to posthumous evaluation

Judging the validity of a disputed will is complex; however, one of the main issues is what the mental status of the testator was at the time of the will. If the will is handwritten, a handwriting analysis can provide information on the mental status of the testator. We tested how two writing parameters (the "writing score," a novel evaluation scale that we previously described, and the percentage of spelling mistakes) are capable to identify cognitively impaired persons. These parameters are especially helpful because they can be used to evaluate the mental status of a deceased person. We found a significant correlation between either parameter and established scales of neuropsychological evaluation (Mini Mental State Examination and Milan Overall Dementia Assessment scale). Specifically, a poor score on either parameter reliably identified a compromised cognitive status. These may represent helpful additions to existing techniques in posthumously identifying persons with severe cognitive impairment.