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.     

Morbidity Involving the Hallucinogenic Designer Amines MDA and 2C‐I*

Abstract: A case is presented of a 39‐year‐old woman who suffered severe debilitation because of a hemorrhagic stroke in the context of substance abuse. The patient presented to the emergency room with rapidly diminishing mental status, hypertension, and vasoconstriction; her friends provided a history of ingestion of cocaine, 3,4‐methylenedioxymethamphetamine (MDMA), and 2C‐I, a novel designer amine. A multi‐targeted LC‐MS/MS method for sympathomimetic amines and related drugs in urine detected and quantified 2C‐I and MDA, while ruling out MDMA. The cause of the stroke was determined to be an underlying cerebrovascular abnormality called Moyamoya, secondary to substance abuse. In clinical laboratories, gas chromatography–mass spectrometry or liquid chromatography–tandem mass spectrometry (LC‐MS/MS) confirmation of a positive amphetamine immunoassay is usually directed only towards amphetamine, methamphetamine, MDMA and MDA. This report demonstrates the utility of testing for a wider menu of compounds using LC‐MS/MS in order to better characterize the prevalence and toxicities of novel amines such as 2C‐I.     

Delirium Due to Intoxication from the Novel Synthetic Tryptamine 5‐MeO‐DALT

Synthetic tryptamines have gained popularity for their hallucinogenic properties, unscheduled status, and availability from “head shops” and through the internet. Here, we present a case of synthetic tryptamine‐induced delirium secondary to 5‐MeO‐DALT ingestion in a previously healthy young male. 5‐MeO‐DALT led to the hospitalization of our patient after ingestion of a standard dose, presenting with extreme agitation, tachycardia, diaphoresis, and combativeness leading to physical restraint and intravenous sedation. A search of PubMed, Ovid, and Google Scholar for keywords of “5‐MeO‐DALT,” “5‐methoxy‐N,N‐diallyltryptamine,” or “Lucy‐N‐Nate” found no case reports or clinical articles in the literature. Rapid emergence and commercialization of this novel synthetic tryptamine 5‐MeO‐DALT points to the importance of health care and forensic professionals keeping abreast of the latest drugs of abuse and their clinical features. The authors hope this report leads the way in disseminating the potential risks associated with unscheduled and unregulated substances, synthetic tryptamines such as 5‐MeO‐DALT in particular.     

HUNTER‐GATHERER COLLABORATIVE PRACTICE

This article describes the development of a practice group based on a hunter‐gatherer model, with the mission of providing high quality collaborative divorce services, with an emphasis on protecting children and divorcing partners, and expanding access to middle‐ and lower‐income families. The practice group professional disciplines include law, mental health divorce coaching, co‐parent coaching, financial analysis, and case administration. These professionals have collectively associated their individual practices to address challenges facing their collaborative practices. With common purpose, the practice group builds skills, generates client base, nurtures trust, and lays a common knowledge base. Collaborative divorce teams formed from its members serve divorcing families with efficient, cost‐conscious, interest‐based negotiation processes that protect children and help parties productively move on with their lives.     

Fatality of 33‐Year‐Old Man Involving Kratom Toxicity

Kratom is an herbal product commonly used for its effects which are similar to opioids and stimulants. Few studies demonstrate the dangers and lethality of Kratom, and most fatalities from Kratom involve other abused substances. In the current case report, a 33‐year‐old white man with a known history of opioid abuse and mental illnesses was found unresponsive in his basement with no obvious signs of trauma. After resuscitative efforts, he was pronounced dead and taken for autopsy evaluation. Blood from the inferior vena cava was analyzed for common abused substances. The laboratory toxicology work‐up revealed positive findings of caffeine, cotinine, and naloxone with low levels of Δ‐9 tetrahydrocannabinol. However, a marked level of mitragynine at 1.9 mg/L was observed, the highest reported to date. Given the facts and evidence, the medical examiner certified the cause of death as “mitragynine toxicity” and the manner of death was classified as an “accident.”     

Fatty liver, encephalopathy, and sudden unexpected death in early childhood due to medium-chain acyl-coenzyme A dehydrogenase deficiency.

A case of sudden death associated with fatty liver and encephalopathy is described in a 4-year old white boy with medium-chain acyl-coenzyme A dehydrogenase (MCAD) deficiency. The death was caused by hypoglycemia triggered by fasting and vomiting associated with a minor viral infection. The differential diagnosis of the hepatoencephalopathy is discussed in relation to other conditions, especially Reye's syndrome. The forensic pathologist should be familiar with MCAD and other deficiencies of beta-oxidation of fatty acids as a cause of sudden unexpected death in children in order to advise parents in genetic counseling to prevent disability or death of other affected, but still asymptomatic siblings.     

Development of a Real‐Time PCR‐Based Method for Analyzing Semen‐Specific Unmethylated DNA Regions and Methylation Status in Aged Body Fluid Stains

The detection of semen in forensic investigation is considered important evidence of sexual assault. In this study, we report the development of a real‐time polymerase chain reaction‐based method for identifying semen that can simply and rapidly analyze the semen‐specific unmethylated region of the DACT1 gene. Using two fluorescent probes designed for the methylated or unmethylated status, this method could perform quantitative analysis of the methylation status in this region. Furthermore, this method was used to analyze various body fluid samples, including 29‐year‐old semen and blood stains. The results showed that this method can detect almost exclusively semen or nonsemen signals even in highly decomposed samples, while a few semen or nonsemen samples showed slight signals of the other fluorescence probe. Although there is still a need for further analysis such as setting thresholds to analyze unknown samples, this method could be a useful supplementary tool for identifying semen, especially in old stains such as those in cold‐case investigations.     

THE EFFECT OF CRIMINAL BACKGROUND CHECKS ON HIRING EX‐OFFENDERS*

Research Summary The rapid increase in the nation's incarceration rate over the past decade has raised questions about how to reintegrate a growing number of ex‐offenders successfully. Employment has been shown to be an important factor in reintegration, especially for men over the age of 27 years who characterize most individuals released from prison. This article explores this question using unique establishment‐level data collected in Los Angeles in 2001. On average, we replicate the now‐common finding that employer‐initiated criminal background checks are negatively related to the hiring of ex‐offenders. However, this negative effect is less than complete. The effect is strongly negative for those employers that are legally required to perform background checks, which is not surprising because these legal requirements to perform checks are paired with legal prohibitions against hiring ex‐offenders. However, some employers seem to perform checks to gain additional information about ex‐offenders (and thus hire more ex‐offenders than other employers), and checking seems to have no effect on hiring ex‐offenders for those employers not legally required to perform checks. Policy Implications One public policy initiative that has received considerable attention is to deny employers access to criminal history record information, which includes movements to “ban the box” that inquires about criminal history information on job applications. The assumption underlying this movement is that knowledge of ex‐offender status leads directly to a refusal to hire. The results of this analysis show that policy initiatives aimed at restricting background checks, particularly for those firms not legally required to perform checks, may not have the desired consequences of increasing ex‐offender employment. This result is consistent with an alternative view that some employers care about the characteristics of the criminal history record and use information about criminal history in a more nuanced, nondiscrete way.     

SELF‐CONTROL AND VICTIMIZATION: A META‐ANALYSIS

A consequential development in victimization theory and research was the idea that individuals with low self‐control self‐select into the various risky behaviors that may ultimately result in their victimization. To establish the empirical status of the self‐control–victimization link, we subjected this body of work to a meta‐analysis. Our multilevel analyses of 311 effect size estimates drawn from 66 studies (42 independent data sets) indicate that self‐control is a modest yet consistent predictor of victimization. The results also show that the effect of self‐control is significantly stronger when predicting noncontact forms of victimization (e.g., online victimization) and is significantly reduced in studies that control directly for the risky behaviors that are assumed to mediate the self‐control–victimization link. We also note that the studies assessing self‐control and victimization are not representative of victimization research as a whole, with intimate partner violence (IPV), violence against women, and child abuse being severely underrepresented. We conclude that future research should continue to examine the causal processes linking self‐control to victimization, how self‐control shapes victims’ coping responses to their experience, and whether self‐control matters in contexts where individuals may have limited autonomy over the behavioral routines that put them at risk for victimization.     

Co‐Parent Court: A Problem‐Solving,Community‐Based Model for Serving Low‐Income Unmarried Co‐Parents

The Hennepin County Co‐Parent Court Project was a 3‐year demonstration project for unmarried co‐parents. The goal of the project was to remove barriers to co‐parenting in low‐income, unmarried parents. The Co‐Parent Court Project encompassed a number of services, including educational workshops, individual case management, parenting plans, legal mediation, and, if needed, supports and treatment for domestic violence. There are published articles that highlight the participant outcomes of the Co‐Parent Project. This article, however, focuses on the background for why this project was developed, components of this project, and lessons learned from implementation.     

Identification of Risk Factors for Self‐Injurious Behavior in Male Prisoners*

Abstract: Male prisoners with (n = 132) and without (n = 132) histories of engaging in self‐injurious behavior (SIB) were matched on conviction prefix and custody level. Conditional logistic regression revealed that a combination of risk factors from domains defined by developmental, offense history, mental health, and institutional functioning factors correctly classified 93% of the prisoners in the sample (ROC AUC = 0.89, S.E. = 0.005, p < 0.0001). Model specificity was 92.6% and sensitivity was 95.3%. False positive and false negative rates were 2.3% and 3.4%, respectively. Implications for the assessment of prisoners at risk for SIB as well as suggested future directions for SIB prisoner research are discussed.     

Distribution of ∆9‐Tetrahydrocannabinol and 11‐Nor‐9‐Carboxy‐∆9‐Tetrahydrocannabinol Acid in Postmortem Biological Fluids and Tissues From Pilots Fatally Injured in Aviation Accidents

Little is known of the postmortem distribution of ?⁹‐tetrahydrocannabinol (THC) and its major metabolite, 11‐nor‐9‐carboxy‐?⁹‐tetrahydrocannabinol (THCCOOH). Data from 55 pilots involved in fatal aviation accidents are presented in this study. Gas chromatography/mass spectrometry analysis obtained mean THC concentrations in blood from multiple sites, liver, lung, and kidney of 15.6 ng/mL, 92.4 ng/g, 766.0 ng/g, 44.1 ng/g and mean THCCOOH concentrations of 35.9 ng/mL, 322.4 ng/g, 42.6 ng/g, 138.5 ng/g, respectively. Heart THC concentrations (two cases) were 184.4 and 759.3 ng/g, and corresponding THCCOOH measured 11.0 and 95.9 ng/g, respectively. Muscle concentrations for THC (two cases) were 16.6 and 2.5 ng/g; corresponding THCCOOH, “confirmed positive” and 1.4 ng/g. The only brain tested in this study showed no THC detected and 2.9 ng/g THCCOOH, low concentrations that correlated with low values in other specimens from this case. This research emphasizes the need for postmortem cannabinoid testing and demonstrates the usefulness of a number of tissues, most notably lung, for these analyses.     

Hard Times for Hard Bans: Fixed‐Term Work and So‐Called Non‐Regression Clauses in the Era of Flexicurity

This paper deals with the issue of non‐regression clauses, which, despite a twenty‐year history, has been addressed by domestic and European case law only recently, and only with regard to the field of flexible employment. This essay argues that the Court of Justice case law on non‐regression clauses (the Mangold and Angelidaki rulings) leads to a weakening of these instruments, rendering them ineffective. This ineffectiveness is due to the controversial idea of Fixed‐Term Work in the era of flexicurity, and to the difficult justiciability of the particular clause in itself, as demonstrated by the most recent Court of Justice's ruling, Sorge. In addition, this essay provides an explanation of the difficult enforcement of non‐regression clauses, in light of the new course of European employment policies.     

Cognitive‐Behavioral Methods in High‐Conflict Divorce: Systematic Desensitization Adapted to Parent–Child Reunification Interventions

Children who are triangulated into their parents' conflicts can become polarized, aligning with one parent and rejecting the other. In response, courts often order families to engage mental health professionals to provide reunification interventions. This article adapts empirically established systematic desensitization and flooding procedures most commonly used to treat phobic children as possible components of a larger family systems invention designed to help the polarized child develop a healthy relationship with both parents. Strengths and weaknesses of these procedures are discussed and illustrated with case material.

Key Points for the Family Court Community
• Family law and psychology agree that children should have the opportunity to enjoy a healthy relationship with both parents
• Adult conflict can polarize a child's relationships, including rejection of one parent
• Existing clinical and forensic “reunification” strategies often prove inadequate
• Reliable and valid cognitive behavioral methods can be adopted to facilitate this process
• A cognitive‐behavioral “exposure‐based” reunification protocol is discussed

     

Unexpected Serotonin Syndrome,Epileptic Seizures,and Cerebral Edema Following 2,5‐dimethoxy‐4‐bromophenethylamine Ingestion

4‐bromo‐2,5‐dimethoxyphenethylamine (2C‐B) is a designer drug. In Europe, 2C‐B is easily obtained and used for recreational purposes. It is known for its stimulating effects similar to those of 3,4‐methylenedioxymethamphetamine, although in higher doses it has more hallucinogenic effects. Here, we report a case of 2C‐B ingestion, confirmed by liquid chromatography‐tandem mass spectrometry, in an 18‐year‐old man. The neurological consequences were severe, including the development of serotonin syndrome and severe brain edema. Supportive therapy resulted in a stable condition, although, after several months, the patient still suffered from severe neurological impairment due to the drug‐induced toxicity. This case showed that 2C‐B could not be identified with the drugs of abuse screening routinely used in Dutch hospitals. The use of 2C‐B carries many risks, with potentially profound neurological damage, that both consumers and healthcare physicians are unaware of.     

Alcohol‐Induced Osteopenia Among In‐Custody and Homicide Deaths from the Harris County Institute of Forensic Sciences

Four cases of in‐custody or unlawful death are presented as examples of increased bone fragility with an associated increase in fracture rates due to ethanol‐induced osteopenia. In addition, one of the individuals suffered fractures several weeks premortem, allowing some healing to take place. Using radiographs and physical examination, the ribs from these individuals are compared with those retained from three individuals with no history of alcoholism to illustrate diagnostic characteristics that will be notable using standard autopsy and anthropological procedures. Trabecular bone mass is notably decreased in the alcoholic group leading to a greater chance of fracture occurring during conflict, including arrest and in‐custody situations. The average number of perimortem fractures among the alcoholic individuals is 15, while the control group is six. In the case of the individual with healing, the degree of bone repair on the ribs was less than is expected considering the interval between injury and death.     

Failings of Trauma‐Specific and Related Psychological Tests in Detecting Post‐Traumatic Stress Disorder in Forensic Settings

Judges and juries tend to be particularly impressed by test data, especially quantitative test data. Psychometric tests specific for assessing the presence of post‐traumatic stress disorder (PTSD) are commonly employed by forensic mental health evaluators. Most of these instruments, however, have been designed to detect PTSD in treatment or research, and not forensic, settings. Those who rely on these measures without adequate awareness of their often significant limits in correctly identifying malingering may induce finders of fact to inordinately confidently accept the presence of PTSD. This article reviews problematic structural and content components of trauma‐specific and related instruments used to evaluate PTSD and discusses the utility of specific techniques liable to be used in forensic settings to “fool” these measures.     

Identification of 2‐(ethylamino)‐1‐(4‐methylphenyl)‐1‐pentanone (4‐MEAP), a New “Legal High” Sold by an Internet Vendor as 4‐Methyl Pentedrone

Online vendors are offering a new legal high, 4‐methylpentedrone (4‐MPD). Information for potential users provided by internet vendors of 4‐MPD includes incorrect structures and nonexistent CAS numbers. A sample of 4‐MPD was obtained and analyzed using GC‐MS, NMR, and LC‐EIS. The fragmentation data from the GC‐MS and LC‐EIS produced an M‐1 ion that suggested the molecular mass was 219 amu, rather than 205 amu as calculated for 4‐methylpentedrone. The difference in molecular mass corresponded to the addition of a methyl group. Based on the mass and fragmentation pattern, two standards were synthesized, 2‐(ethylamino)‐1‐(4‐methylphenyl)‐1‐pentanone and 1‐(4‐methylphenyl)‐2‐(propylamino)‐1‐butanone. The synthesis involved bromination of the appropriate ketone followed by the reaction with ethylamine or propylamine. Based on the NMR data and unique fragmentation patterns produced by these molecules, the sample was identified as 2‐(ethylamino)‐1‐(4‐methylphenyl)‐1‐pentanone, not 4‐methylpentedrone.     

Determination of Acetamiprid and IM‐1‐2 in PostMortem Human Blood,Liver, Stomach Contents by HPLC‐DAD

An HPLC‐DAD method was developed to detect and quantify a neonicotinoid insecticide acetamiprid (ATP) and its metabolite IM‐1‐2 in autopsy samples of a fatal intoxication case. The postmortem blood and tissue distribution of ATP and IM‐1‐2 was determined for the first time. The method showed acceptable precisions and recoveries with relative standard deviations of <10% for ATP level and 1.38 % for IM‐1‐2. The detection and quantification limits for ATP were 0.015 μg/mL and 0.030 μg/mL for blood and were 0.035 μg/g and 0.050 μg/g for liver samples, respectively. The mean contents of ATP were 0.79 μg/g in the liver, 47.35 μg/g in the stomach contents and 2.7 μg/mL in the blood. IM‐1‐2 content was 17.0 μg/g in the stomach contents. ATP and IM‐1‐2 were not detected in the urine. The presence of ATP and IM‐1‐2 in the samples was confirmed by GC‐MS. The method can be exploited in future forensic casework.     

Identification of furosemide in hair in a post‐mortem case by UHPLC‐MS/MS with guidance on interpretation

Testing for drugs in hair raises several difficulties. Among them is the interpretation of the final concentration(s). In a post‐mortem case, analyses revealed the presence of furosemide (12 ng/mL) in femoral blood, although it was not part of the victim's treatment. The prosecutor requested our laboratory to undertake an additional analysis in hair to obtain information about the use of furosemide. A specific method was therefore developed and validated to identify and quantify furosemide in hair by UHPLC‐MS/MS. After decontamination of 30 mg of hair, incubation in acidic condition, extraction with ethyl acetate, the samples were analyzed by UHPLC‐MS/MS. Furosemide was found in the victim's hair at 225 pg/mg. However, it was not possible to interpret this concentration due to the absence of data in the literature. Therefore, the authors performed a controlled study in two parts. In order to establish the basis of interpretation, several volunteers were tested (four after a single 20 mg administration and twenty‐four under daily treatment). The first part indicated that a single dose is not detectable in hair using our method. The second part demonstrated concentrations ranging from 5 to 1110 pg/mg with no correlation between dosage and hair concentrations. The decedent's hair result was interpreted as repeated exposures. In the case of furosemide analysis, hair can provide information about its presence but cannot give information about dosage or frequency of use.