Neurocognitive Disorders in DSM-V: Forensic Perspective

Although determination of diagnosis of cognitive impairments constitutes one of the core objectives of forensic neuropsychological assessment, the diagnostic criteria for cognitive disorders provided by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, American Psychiatric Association 2000) have been of low internal and external validity and limited utility. This paper reviews the evolution of diagnosis of cognitive disorders from current DSM-IV-TR to the proposed DSM-V (American Psychiatric Association 2010). The conceptual framework is tracked, along with the body of literature associated with the DSM-V proposal on Minor and Major Neurocognitive Disorders. The quality of evidence for internal and external validity is reviewed, as well as the fairness and utility of newly proposed diagnoses from both clinical and forensic perspectives. Significant conceptual, evidentiary, psychometric, assessment, and practical questions are raised related to the new classification, and recommendations are offered for improvement to the proposal of the DSM-V Work Group on Neurocognitive Disorders.     

Russian Grand Strategy and the United States in the 21st Century

Despite the initially cordial relationship between the United States and Russia following the September 11, 2001 attacks, the Iraq War became a turning point in what evolved into the worst relationship between Moscow and Washington since the Cold War. From that point onwards, Russia persistently has exhibited aggressive behavior toward the United States, resulting in numerous crises. This article argues that this Russian assertiveness is deliberate, arising from a mixture of domestic and international factors. In light of recent developments in U.S.-Russian relations, especially the decision of American President Barack Obama to abandon the Bush Administration's scheme to deploy national missile defense (NMD) system in Eastern Europe, it is important to understand that Russia's grand strategy is aimed at promoting multipolarity and that Moscow is willing to apply limited military force to achieve its goals. The Obama Administration should engage Russia, but be prepared to confront it if necessary.     

Expressions of IL -1α, IL -1β and IL -13 mRNA in Lung Tissue and Serum of Rats Drown in Fresh WaterCSCD

Objective: To detect the changes of (interleukin, IL)-1α, IL-1βand IL-13 mRNA in lung tissue and serum of drown rats, and to explore the potential value for the diagnosis of drowning in forensic practice. Methods: Eighteen SD rats were randomly divided into drowning group, blank control group and myocardial infarction group (as control group). The serum of right ventricular, the inferior lobe of right lung and the myocardium were taken from the rats in different groups. The expressions of IL- 1α, IL-1βand IL-13 mRNA in the lung tissue and the serum of right ventricular were detected by TaqMan probe method. Results: The expression differences of IL-1α, IL-1βand IL-13 mRNA in lung tissue between drowning group and blank control group, myocardial infarction group were not statistically significant (P>0.05). The expression of IL-1βand IL-13 mRNA in serum of right ventricular increased (P<0.05). The expression differences of IL-1α, IL-1βand IL-13 mRNA in serum between blank control group and myocardial infarction group were not statistically significant (P>0.05). Conclusion: The changes of cytokines IL-1βand IL-13 mRNA in the serum of right ventricular of drown rats are statistical significance, which are highly correlated with drowning. © 2018 by the Editorial Department of Journal of Forensic Medicine.     

Beyond Traumatic Brain Injury: Advancing Forensic Neuropsychological Assessment

As research on the cognitive impact of medical conditions and mental health disorders advances, it is imperative for forensic neuropsychologists to stay abreast of rapidly accumulating new empirical evidence from neuroscience and neuropsychology to disentangle multiple determinants of cognitive impairment. Although medicolegal neuropsychological assessments traditionally focused on traumatic brain injury (TBI) sequelae, it is equally important to consider the potential impact of any other acquired, or secondarily induced brain impairments, regardless of their source. Such injuries or conditions are at times assumed to cause a lesser cognitive impact than TBIs; however, their effects depend entirely on the factor in question. Injuries and illnesses implicated in civil litigation—and eventually affecting competency—can indeed involve TBI, but also anoxic/hypoxic injuries, pain, depression, posttraumatic stress disorder (PTSD), sensory deficits (e.g., tinnitus), and fatigue, and all, in turn, can affect an individual’s cognitive function and quality of life. Impairments caused by these conditions can be disabling and resistant to treatment, particularly, when the treatment is based on incorrect diagnostic, prognostic, and causality assumptions.     

Anoxia-Hypoxia in Forensic Neuropsychological Assessment: Cognitive Impact of Pulmonary Injuries,Respiratory Distress,Cerebral Blood Hypoperfusion,and Major Surgeries

Pulmonary injuries, respiratory distress, blood loss-related cerebral blood perfusion, and major surgeries are common features of medical histories in forensic neuropsychological assessments. Unless the explicit reason for referral is determination of the cognitive impact of one of these adverse medical conditions, their contribution to neuropsychological causality determination can be overlooked, minimized, or misattributed to other causes. Given the underlying common denominator among these conditions, that is, sub-optimal oxygen delivery to the brain, transient or long-term debilitating injuries causing neuropsychological change of various degrees can result. A thorough understanding of the impact of these medical events is paramount in forensic neuropsychological assessment for diagnosis, causality, and functional impact determination, prognosis, rehabilitation, and recommendations. In this paper, we critically review the available empirical evidence regarding anoxia and hypoxia arising from pulmonary injuries and respiratory distress, cerebral blood hypoperfusion, and major surgeries, together with evidence of their impact on cognitive functioning. Medical and psychological electronic search engines [PubMed, PsycINFO, and Google Scholar (up to January 2018)] have been screened for neuroscience-related and neuropsychological literature pertaining to pulmonary injuries and respiratory distress, cerebral blood perfusion, and major surgeries, and subsequently optimized for the issue under review.     

DSM-5 Neurocognitive Disorders: Validity, Reliability, Fairness, and Utility in Forensic Applications

A previously published paper (Schultz Psychological Injury and Law 3: 271–288, 2010) on forensic considerations regarding neurocognitive disorders within the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5; American Psychiatric Association, 2013) reviewed evidence for internal and external validity, as well as the fairness and utility of the proposed classification. Given recent publication of the DSM-5, in May 2013, the current paper provides an update on this review. It focuses on changes in the final version of the neurocognitive disorders section of the DSM-5 as compared with the earlier proposal in 2010 and raises a range of new conceptual, methodological, and clinical practice issues related to this classification. An examination of forensic neuropsychologists’ diagnostic choices and their associated pitfalls follows. Discussion extends to the unresolved issue of disorder threshold, associated risks of overdiagnosis of mild neurocognitive disorder and underdiagnosis of major neurocognitive disorder, and the absence of a moderately severe disorder classification. Methodological concerns in diagnostic determinations, especially with DSM-5 Criteria A and B, issues associated with subtypes and specifiers, as well as functional assessments of activities of daily living, now embedded in the diagnosis, follow. Subtype omissions and methodological inconsistencies are highlighted.The vulnerability of neuropsychologists and psychiatrists during courtroom testimony on neurocognitive disorders-particularly with conceptual, methodological, and practical issues-will be addressed through clinical and forensic practice recommendations.     

Early Intervention with Compensated Lower Back-Injured Workers at Risk for Work Disability: Fixed versus Flexible Approach

Low back pain (LBP), a leading cause of disability, has been linked with profound economic, personal, and social costs (Hills 2006; World Health Organization 2003). This significant effect propels research in identifying modifiable risk factors that protract LBP; these factors can be targeted in early intervention (EI) (Pransky, Journal of Occupational & Environmental Medicine, 49(3):249–251, 2007; Schultz et al., Journal of Occupational Rehabilitation, 17:327–352, 2007, Journal of Occupational Rehabilitation, 18(2), 140–151, 2008; White et al. 2013). This randomized controlled study evaluated the effectiveness of two approaches, fixed versus flexible, in delivering proactive, interdisciplinary EI with 63 workers within a workers' compensation interdisciplinary case management setting (i.e., WorkSafeBC, Canada). Off-work 4 to 10 weeks post-back injury, the workers were also at risk of protracted work disability (N?=?24 at high risk; N?=?39 at moderate risk). Fixed, protocol-driven, interdisciplinary, multimodal, clinical, occupational, and case management-based EI was compared with a flexible, individual need-driven EI with the same modalities as the fixed approach. Results showed a significant narrowing of the outcome gap between the two interventions. High-risk injured workers tended to benefit more from a fixed, protocol-driven approach, as shown in the pilot study (Schultz et al. Journal of Occupational Rehabilitation, 18(2), 140–151, 2008). The results indicated that moderate-risk workers benefitted from a more flexible, need-based, individual, and low-intensity approach as compared with a fixed approach. The flexible approach for moderate-risk workers was also less costly and consumed fewer rehabilitation and health care resources. Recommendations for future research and practice included larger sample sizes, controllability of research interventions, risk for disability-EI matching, and conditions under which a flexible delivery of multimodal EI is more efficacious than a fixed approach, and vice versa.     

Commerce and institutions: Trade, scope, and the design of regional economic organizations

The design of current regional economic organizations (REOs) is remarkably diverse. Some REOs address numerous economic issues, while others have only limited mandates. Some REOs have an independent bureaucracy and a legalized dispute settlement mechanism (DSM), while others do not. What determines this institutional variation? Thinking about these institutions as devices that generate credible commitment to a rule-based regional cooperation, institutionalists maintain that the intensity of commercial ties determine regional institutionalization and institutional independence. A number of studies question this logic and argue that it is “naïve.” Empirical evidence on the links between commerce, economic scope, and regional institutions is scant, however. Using an original data set that contains detailed information on the economic activities and institutional structure of twenty-eight REOs over three decades, this paper presents one of the first systematic analyses of these relationships. The empirical analysis indicates that the institutionalist wisdom is right after all. It shows that higher levels of regional trade are associated with greater institutionalization and economic scope, but only if implementation of signed agreements is accounted for, and that regional commerce and greater economic scope are associated with more independent bureaucracies and more legalized DSMs.