Diagnostic and Statistical Manual-III: a perspective from family court

The third edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-III) is evaluated from the standpoint of forensic science experience in a family court setting. The importance of diagnosis in developing pertinent recommendations within an adversarial system is discussed, with particular emphasis on difficulties in coordinating the Manual with the mental disorders frequently found in such a population. The limitations of the current criteria of the developmental disabilities are noted, and problems of reconciling incest and child abuse with the nomenclature are investigated. Some inconsistencies in the conceptualization of the conduct disorders and antisocial personality disorder are explored in terms of the needs of the juvenile justice system. An additional coding procedure is proposed for DSM-III, in order to identify more easily prodromal or emerging disorders of clinical significance.     

The effects of complainant age and expert psychological testimony in a simulated child sexual abuse trial

Mock jurors viewed a videotape of a simulated child sexual abuse trial and then deliberated to a unanimous verdict. The complainant was described as either a 13- or 17-year-old female child. Jurors voted to convict more often when the younger complainant was seen, and the younger complainant was rated as more credible than the older complainant. Female jurors voted the defendant guilty more often and rated the complainant as being more credible than male jurors. Jurors voted to convict more often and rated the defendant as less credible when expert psychological testimony was specific to the case than when they were presented with either general expert testimony or no expert testimony. Jurors who saw a psychological expert testify became less accepting of child sexual abuse misconceptions than those in the no expert control condition. The implications of these findings are discussed.Millbrook Correctional Centre     

The consequences of respondent attrition in panel studies: A simulation based on the Rochester youth development study

Subject attrition is a potentially serious threat to the validity of inferences drawn from panel studies of delinquency and drug use. Prior assessments of this issue produce somewhat conflicting results, with some finding that respondents who leave the panel have higher rates of delinquency and drug use than those who remain, while other studies report little or no differential attrition. Despite these findings, there has been virtually no examination of the extent to which respondent attrition can bias substantive findings in panel studies of delinquency and drug use. The present article addresses this issue by simulating higher levels of attrition in an ongoing panel study that has a low rate of attrition and little differential attrition. It finds that failure to include more elusive respondents (those who are more mobile) would bias estimates of prevalence and frequency of delinquency and drug use as well as results from basic regression analyses. Failure to include less cooperative respondents (those who require more contacts) produces similar, but somewhat smaller, differences. The methodological implications of the results are discussed.     

The right to refuse treatment and the movement for mental health reform

The right to refuse treatment is the most controversial of the rights of mental patients, and usually polarizes the movement for mental health reform between providers of care and external activist reformers. A broad alliance supported earlier struggles for recognition of patients' rights, but most professionals oppose recognizing this most extreme right of treatment refusal. Professional opposition to treatment refusal is not based on a wide extent of actual refusal; rather it derives from a defense against challenges to professional and institutional autonomy, an opposition to legal interference, and a belief that the community as well as the patient must be protected. These three reasons for opposition are examined by reviewing studies of attitudes toward patients' rights, knowledge about patients' rights, and implementation of patients' rights. Finally, the implications of these studies for future directions in the movement for patients' rights are examined.     

Hospital mergers and antitrust: an economic analysis

The hospital industry has recently experienced substantial merger activity. This paper examines several actual and proposed hospital mergers to determine the extent of competition in the affected markets and the effect these mergers may have on competition. Our focus is on mergers between hospitals in the same market. We define the relevant product and geographic market for hospitals, then develop criteria for evaluating hospital mergers and analyze several merger cases using these criteria. We conclude that these mergers threaten the competition that exists in most of the markets discussed, and that the claimed efficiency justification for mergers is not convincing.     

Recovery and evaluation of trace material from wound edges in traumatic injury site

A small wound found on the ear of a homicide victim was inflicted by either a knife or a sharp fragment of ceramic. To test the potential usefulness of cytologic examination of wound edges for fragments of inert material from the assault weapon, the wound was rinsed and cytologic filters were prepared from the retained rinsing material. The particulate matter present on filters included microscopic fragments of crockery admixed with blood and other tissue components. This observation supported other physical evidence that the wound was caused by the sharp edge of a ceramic crock rather than by the knife. This case demonstrates the potential usefulness of cytologic examination of wound edges.     

Fatal small intestinal infarction due to occlusion by mesenteric carcinoid tumor

A case of sudden death due to massive small intestinal infarction is reported. The cause of the intestinal infarction was occlusion of mesenteric vessels by massive fibrosis secondary to carcinoid tumor. Since no primary carcinoid tumor was found in the intestine or elsewhere, it is suggested that the carcinoid tumor had originated in the mesentery.