Mental Capacity in Patients Involuntarily or Voluntarily Receiving Psychiatric Treatment for an Acute Mental Disorder

Despite the growing amount of data, much information is needed on patients' mental capacity to consent to psychiatric treatment for acute mental disorders. The present study was undertaken to compare differences in capacity to consent to psychiatric treatment in patients treated voluntarily and involuntarily and to investigate the role of psychiatric symptoms, competency, and cognitive functioning in determining voluntariness of hospital admission. Involuntary patients were interviewed with the MacArthur Competence Assessment Tool for Treatment (MacCAT‐T), the 24‐item Brief Psychiatric Rating Scale (BPRS), the Mini Mental State Examination (MMSE) and the Raven's Colored Progressive Matrices, and their data were compared with those for age‐ and sex‐matched voluntary patients. Involuntary patients performed worse in all MacCAT‐T subscales. Capacity to consent to treatment varied widely within each group. Overall, involuntary patients have worse consent‐related mental capacity than those treated voluntarily, despite capacity to consent to treatment showing a significant variability in both groups.     

A Test of Hartnett's Revisions to the Pubic Symphysis and Fourth Rib Methods on a Modern Sample

Estimating age at death is one of the most important aspects of creating a biological profile. Most adult age estimation methods were developed on North American skeletal collections from the early to mid‐20th century, and their applicability to modern populations has been questioned. In 2010, Hartnett used a modern skeletal collection from the Maricopia County Forensic Science Centre to revise the Suchey‐Brooks pubic symphysis method and the ??can et al. fourth rib methods. The current study tests Hartnett's revised methods as well as the original Suchey‐Brooks and ??can et al. methods on a modern sample from the William Bass Skeletal Collection (N = 313, mean age = 58.5, range 19–92). Results show that the Suchey‐Brooks and ??can et al. methods assign individuals to the correct phase 70.8% and 57.5% of the time compared with Hartnett's revised methods at 58.1% and 29.7%, respectively, with correctness scores based on one standard deviation of the mean rather than the entire age range. Accuracy and bias scores are significantly improved for Hartnett's revised pubic symphysis method and marginally better for Hartnett's revised fourth rib method, suggesting that the revised mean ages at death of Hartnett's phases better reflect this modern population. Overall, both Hartnett's revised methods are reliable age estimation methods. For the pubic symphysis, there are significant improvements in accuracy and bias scores, especially for older individuals; however, for the fourth rib, the results are comparable to the original ??can et al. methods, with some improvement for older individuals.     

利用中国汉族成人股骨上端CR片特征判定年龄

目的探讨中国汉族成人股骨上端CR片的特征随年龄变化的规律,以推断年龄。方法 277例中国汉族成人骨盆正位CR片,其中男性139例,年龄范围18-83岁,女性138例,年龄范围18-85岁,选取股骨上端的股骨头、股骨颈、大转子内的骨小梁及股骨上端髓腔高度四项指标,观察不同年龄各指标的变化进行统计分析。结果成人股骨头、股骨颈骨小梁变化和股骨上端髓腔高度是影响45岁以下年龄变化的重要因素,股骨大转子影响较小。四项指标对45岁以上年龄组均是影响年龄变化的重要因素。利用以上指标建立的回归方程能很好的反映成人股骨上端的增龄性变化,预测骨龄较为准确。结论利用成人股骨头、股骨颈、股骨大转子内骨小梁的改变及股骨上端髓腔高度变化可推断年龄。     

Intellectual Quotient of Juveniles Evaluated in a Forensic Psychiatry Clinic After Committing a Violent Crime*

Abstract: The purpose of this preliminary study is to evaluate if there is a difference between the intelligence quotient (IQ) of 27 adolescent defendants referred to the Bellevue Hospital Center Forensic Psychiatry Clinic after committing violent crimes, and those adolescents in the same age group in the general population of the United States, as defined by the norms of the psychometric testing instrument Wechsler Intelligence Scale for Children, 4th edition (WISC‐IV). The IQ scores and sub‐scores were compared to IQ scores of the general population (mean = 100, SD = 15) using a Z‐test. The mean for the Full Scale IQ was 82.93. The means for the subtests which include Processing Speed Index, Perceptual Reasoning Index, Verbal Comprehension Index, and Working Memory Index, were: 78.48, 87.78, 86.70 (p < 0.05), and 90.78 (p = 0.09) respectively. There is a statistically significant difference in the IQ scores of the violent juveniles studied when compared to the general population.     

A Bayesian Approach to Age‐at‐Death Estimation from Osteoarthritis of the Shoulder in Modern North Americans

Osteoarthritis (OA) is a marker of degeneration within the skeleton, frequently associated with age. This study quantifies the correlation between OA and age‐at‐death and investigates the utility of shoulder OA as a forensic age indicator using a modern North American sample of 206 individuals. Lipping, surface porosity, osteophyte formation, eburnation, and percentage of joint surface affected were recorded on an ordinal scale and summed to create composite scores that were assigned a specific phase. Spearman's correlation indicated a positive relationship between each composite score and age (right shoulder = 0.752; left shoulder = 0.734). Transition analysis revealed a tendency toward earlier degeneration of the right shoulder. Bayesian statistics generated phase‐related age estimates based on highest posterior density regions. Best age estimates were into the seventh decade at the 90th and 50th percentile. The proposed method supplements traditional techniques by providing age estimates beyond a homogenous 50+ age cohort.     

Investigations Into Age‐related Changes in the Human Mandible,

While changes in mandibular shape over time are not widely recognized by skeletal biologists, mandibular remodeling and associated changes in gross morphology may result from a number of causes related to mechanical stress such as antemortem tooth loss, changes in bite force, or alterations of masticatory performance. This study investigated the relationship between age‐related changes and antemortem tooth loss in adult humans via dry bone measurements. This study examined 10 standard mandibular measurements as well as individual antemortem tooth loss scores using the Eichner Index from a total of 319 female and male individuals with ages ranging from 16 to 99 years. Results indicate that few mandibular measurements exhibited age‐related changes, and most were affected by antemortem tooth loss.     

Extending the Practice of Physician‐Assisted Suicide to Competent Minors

In an effort to address the mental and physical suffering terminally ill patients endure, some states have either legalized or decriminalized physician‐assisted suicide—a practice commonly referred to as death with dignity. However, as the practice of physician‐assisted suicide becomes accepted among states, competent minors continue to be excluded from legislative and judicial decisions. Regardless of parental consent, states institute an age requirement of eighteen years old for participants of physician‐assisted suicide. This Note proposes that states amend their physician‐assisted suicide statutes to (1) remove any age restriction, (2) create a standard of competency that minors must meet to be eligible for physician‐assisted suicide, and (3) implement a procedure to determine whether a minor meets the competency standard.     

Age Estimation Based on Pulp Cavity to Tooth Volume Ratio Using Postmortem Computed Tomography Images

Pulp cavity size is known to decrease with age and can therefore serve as an indicator for age estimation. Here, we evaluated whether reconstructed images of multidetector‐row computed tomography (MDCT) acquired before forensic autopsy are useful for estimating age at death. Images of 136 mandibular first premolars obtained from bodies of known age at death were analyzed, and the volume of the regions corresponding to pulp cavity and that of the whole tooth were determined using a voxel counting function. The pulp cavity was clearly distinguishable from dental hard tissue on the reconstructed images when using a cutoff value of 1400 Hounsfield units. Regression analysis adjusted for sex showed that estimated age correlated significantly with the pulp cavity to tooth volume ratio (r = 0.76). MDCT is gaining more widespread use in forensic medicine, and analyzing dental images to obtain parameters for age prediction is a practical approach for postmortem identification.     

A comparison of instruments for assessing competency to stand trial

The present study compared two instruments for assessing competency to stand trial, The Competency Screening Test and a revised version of The Georgia Court Competency Test. in a sample of 140 defendants admitted to the forensic unit of a state hospital for court-ordered pretrial evaluation. Scores on the tests were used to predict staff decisions about competency. Correlates of scores on the two tests also were examined. The tests were highly correlated with one another and with the decisions of forensic examiners. Although neither of these instruments should provide the sole basis for competency decisions, both may be useful components of a comprehensive program of competency evaluation.Portions of this paper were presented at the annual convention of the American Psychological Association, Washington, D.C., August, 1986.     

Homicide,Psychopathy, and Aging—A Nationwide Register‐based Case‐comparison Study of Homicide Offenders Aged 60 Years or Older*

Abstract: With populations aging there have been some concerns on elderly offending. We compared elderly homicide offenders with a younger comparison group with special emphasis on psychopathy. We analyzed nationwide register‐based material on all homicide offenders aged 60 or older who were in a forensic psychiatric examination in Finland 1995–2004 and their gender‐matched comparison group of younger homicide offenders. The offenders 60 years or older were diagnosed less often than the younger ones with drug dependence and personality disorders and more often with dementia and physical illnesses. The mean Psychopathy Checklist—Revised total scores as well as factor and facet scores were lower in the 60 or older age group. The group 60 years or older had significantly lower scores on eight individual items of social deviance. The interpersonal/affective factor 1 scores did not differ. Understanding the possible underlying phenomena of violent behavior may provide help for developing services for the elderly.     

Soilwater Conductivity Analysis to Date and Locate Clandestine Graves of Homicide Victims

In homicide investigations, it is critically important that postmortem interval and postburial interval (PBI) of buried victims are determined accurately. However, clandestine graves can be difficult to locate; and the detection rates for a variety of search methods (ranging from simple ground probing through to remote imaging and near‐surface geophysics) can be very low. In this study, simulated graves of homicide victims were emplaced in three sites with contrasting soil types, bedrock, and depositional environments. The long‐term monthly in situ monitoring of grave soil water revealed rapid increases in conductivity up to 2 years after burial, with the longest study evidencing declining values to background levels after 4.25 years. Results were corrected for site temperatures and rainfall to produce generic models of fluid conductivity as a function of time. The research suggests soilwater conductivity can give reliable PBI estimates for clandestine burials and therefore be used as a grave detection method.     

Contributions from Forensic Imaging to the Investigation of Upper Cervical Fractures

Abstract: Injuries to the upper cervical spine (UCS) are common in traumatic deaths and postmortem computed tomography (PMCT) may contribute to the forensic investigation. This study presents PMCT in comparison with autopsy in the examination of UCS injury. Thirteen consecutive cases with UCS fracture and/or cranio‐cervical dislocation were examined with PMCT and autopsy, and the findings were correlated. Neither of the techniques identified all UCS injuries. Fractures of atlas and axis were best visualized with PMCT whereas cranio‐cervical dislocation was better identified during autopsy. Serious injuries were present after both high‐ and low‐energy trauma. Medico‐legal autopsy in combination with PMCT produced a thorough evaluation of UCS injuries. By combining these procedures detailed investigations, including accident reconstruction and injury pattern analysis, can be performed. This study supports the routine application of PMCT, as a supplement to the medico‐legal autopsy of deaths with UCS injuries.     

Developmental incompetence to stand trial in juvenile courts

Juveniles' competency to participate in delinquency proceedings has received increased attention in recent years. Developmental incompetence, whereby juveniles' incompetency is based upon their immaturity, as opposed to a mental disorder or developmental disability, is an evolving and important aspect of this area of law. The following paper reviews theories used to support the notion of developmental incompetence, as well as the extant empirical research on juveniles' competency-related abilities. Using a LexisNexis search, statutory and case laws pertaining to juvenile competency were identified across the 50 states and the District of Columbia. Only six states clearly allow developmental incompetence, whereas 17 have laws that do not include developmental immaturity as an acceptable basis of incompetence in juvenile courts. Developmental incompetence is likely to affect a relatively small proportion of juvenile cases, but has important implications for juvenile forensic practice. Recommendations are offered for forensic practitioners conducting this type of evaluation.     

Psychophysiological Responses of People with Psychopathic Tendencies to the Concealed Information Test

This study was designed to investigate differences in psychophysiological responses among individuals with psychopathic tendencies. A total 40 students were participated and were divided into two groups based on Levenson Self‐Report Psychopathy Scale (LSRP) scores: a high psychopathic tendency group selected from the top 5% of LSRP scores, and a low psychopathic tendency group selected from the bottom 5% of LSRP scores. All participants were instructed to perform a mock crime and complete the concealed information test (CIT). Results indicate that significant differences between crime‐relevant questions and irrelevant questions were observed for respiration line length and skin conductance response in both groups, but heart rate did not significantly differ between groups. There were no differences in psychophysiological responses between the groups. In conclusion, CIT was found to be an effective method for detecting crime‐relevant information in individuals with psychopathic tendencies.     

A Test of the Revised Auricular Surface Aging Method on a Modern European Population

The accurate age estimation of adults is an important step in the construction of the biological profile of skeletonized remains. The auricular surface of the ilium as it was developed in 1985 by Lovejoy et al., is one of the methods employed for age estimation. This study presents the results of a blind test of the revised auricular surface aging method developed by Buckberry and Chamberlain. A sample of 120 individuals from the Athens Collection was used to test this revised aging technique. Almost all features and composite score were positively correlated with known age‐at‐death. The calculation of bias demonstrated no obvious trend for either overestimation or underestimation of age when all individuals were pooled together. Inaccuracy showed that absolute errors of estimated ages against known ages are substantial. The data generated from this study suggest that the revised method can be reliable for age estimation on a modern European population.     

The Reliability of the Greulich and Pyle Atlas When Applied to a Modern Scottish Population

This study examines the reliability of age estimation utilizing the Greulich and Pyle atlas in relation to a modern Scottish population. A total of 406 left‐hand/wrist radiographs (157 females and 249 males) were age‐assessed using the Greulich and Pyle atlas. Analysis showed that there was a strong correlation between chronological age and estimated age (females R² = 0.939, males R² = 0.940). When age groups were broken down into year cohorts, the atlas over‐aged females from birth until 13 years of age. The pattern for males showed that the atlas under‐estimated age until 13 years of age after which point it consistently over‐aged boys between 13 and 17 years of age. This study showed that the Greulich and Pyle atlas can be applied to a modern population but would recommend that any analysis takes into account the potential for over‐ and under‐aging shown in this study.     

Increased Lung Weights in Drug‐related Fatalities

This study is of autopsy data for potential validation as to whether increased weights of the lungs support toxic effects of drugs as the cause of death. This retrospective study compared data from 133 deaths resulting from the toxic effects of drugs with previously reported normal lung weights (Toxicol Mech Methods, 22, 2012, 159; Am J Forensic Med Pathol 33, 2012, 368). The lung weights and their standard errors were used in a two‐sample independent t‐test comparing the average drug‐related death weight to the average control weights. To account for multiple comparisons, a Bonferroni‐adjusted alpha level of 0.0125 was used. We are 98.75% confident that the mean right lung weight for female drug‐related deaths is between 227 and 377 g greater than the mean right lung weight for female non‐drug‐related deaths. We are 98.75% confident that the mean right lung weight for male drug‐related deaths is between 245 and 378 g greater than the mean right lung weight for male non‐drug‐related deaths.     

Validation of the Acetabulum As a Skeletal Indicator of Age at Death in Modern European‐Americans,

Progressive changes in the acetabulum have been used in modern skeletal age estimation, but they have not been completely understood. If their age correlations are weakened by the influence of factors like physical activity and obesity, acetabular changes should not be used for age estimation. To investigate their utility for aging, the acetabular variables of Rissech et al. (2006) were analyzed in 409 modern European‐Americans (Bass Collection, Tennessee). Correlation tests assessed potential associations between acetabular data, osteoarthritis scores (collected per Jurmain, 1990), and documented demographic information (age, body mass index [BMI], metabolic intensity of physical activities). Acetabular changes had statistically significant, positive correlations with osteoarthritis (p < 0.001 in most joints/regions) and age (p < 0.001), indicating their degenerative nature and relevance for age estimation. Acetabular changes showed no associations with BMI or metabolic values, suggesting resistance to obesity and activity effects. These results suggest that acetabular degeneration is a valid skeletal age‐at‐death indicator.     

Age estimation by measurements of developing teeth: accuracy of Cameriere's method on a Brazilian sample

Developing teeth are commonly the criteria used for age estimation in children and young adults. The method developed by Cameriere et al. (Int J Legal Med 2006;120:49-52) is based on measures of teeth with open apex, and application of a formula, to estimate chronological age of children. The present study evaluated a sample of panoramic radiographs from Brazilian children from 5 to 15 years of age, to evaluate the accuracy of the method proposed by Cameriere et al. The results has proven the system reliable for age estimation, with a median residual error of -0.014 years between chronological and estimated ages (p = 0.603). There was a slight tendency to overestimate the ages of 5-10 years and underestimate the ages of 11-15 years.     

Postdicting arrests for proactive and reactive aggression with the PICTS Proactive and Reactive composite scales

The criminal arrest histories of 262 medium-security male inmates were correlated with the Proactive (P) and Reactive (R) composite scales of the Psychological Inventory of Criminal Thinking Styles (PICTS). As predicted, only scores on the P scale correlated significantly with prior arrests for proactive aggression (robbery, burglary) and only scores on the R scale correlated significantly with prior arrests for reactive aggression (assault, domestic violence) when age, education, race, and marital status were controlled in a series of negative binomial regression analyses. The P and R scales also predicted the total number of arrests received by participants in this sample after these same four demographic measures were controlled. The implications of these results for the construct validity of the PICTS composite scales and for matching offenders to interventions are discussed.