Psycholegal Assessment of Co-occurring Chronic Pain and Schizophrenia Post-MVC: Analysis of Causation Using Two Case Examples

The key aspect of any psycholegal assessment is the analysis of causation, which requires consideration of important legal constructs such as the but for test, material contribution test, thin skull, and crumbling skull. An analysis of causation can be especially helpful in determining overall liability when evaluating the impact of two major co-occurring conditions. This paper focuses on the utility of conducting an analysis of causation using two case examples in which chronic pain and schizophrenia co-occurred following a motor vehicle collision (MVC). Collision-related injuries often lead to the development of chronic pain and could result in permanent and serious impairment and disability. Schizophrenia is a rare psychological occurrence in the collision context and is associated with its own unique and overwhelming physical, psychological, and cognitive challenges. In the psycholegal context, evaluating the impact of two major co-occurring conditions can be problematic and lead to conceptual challenges. In the two cases presented, some assessors attributed nearly all post-collision changes to schizophrenia as if it were pre-existing or in a latent state and failed to assess or even consider the contribution of MVC-related sequelae to the onset of schizophrenia. As part of addressing these conceptual challenges, we present a model of psycholegal assessment that takes into account the pre-, peri- and post-MVC variables that best explain the occurrence of these two conditions. The model also allows the assessor to determine the current and future needs of injured persons, the permanent physical, psychological, and cognitive sequelae that impact quality of life and/or work, and prognosis for the near and distant future.     

The Impact of Psychosocial and Contextual Factors on Individuals Who Sustain Whiplash-Associated Disorders in Motor Vehicle Collisions

Motor vehicle collisions (MVCs) are very common, and they often result in neck and shoulder injuries that are referred to as whiplash-associated disorders (WAD). The largest percentage of WAD are relatively minor and do not reveal any evidence of objective, structural pathology. However, for a substantial percentage of individuals, WAD evolves into chronic, disabling conditions characterized by pain and other symptoms. A range of pre-morbid, collision-related, biomechanical, and psychosocial responses to the MVC have been investigated to determine the manner in which these responses serve to exacerbate and maintain WAD symptoms. In this article, we review the literature investigating these potential causal, amplifying, and perpetuating factors from a biopsychosocial perspective. We emphasize the range of psychological factors and the post-MVC legal and compensation factors that have been identified as significant contributors to the persistence of symptoms and ensuing disability. We highlight the ways in which psychological and legal factors need to be integrated with biological factors to better understand and prevent WAD and treat individuals who experience WAD to reduce chronicity and disability.     

Motor Vehicle Collisions and Their Consequences—Part II: Predictors of Impairment and Disability

A significant number of persons involved in motor vehicle collisions (MVCs) evidence persistent changes in physical, psychosocial, and cognitive functioning consequent to physical injury. While post-injury impairment and disability can sometimes be predicted with knowledge of injury type and injury severity, post-injury experiences of pain, psychological distress, cognitive dysfunction, and role disruption have been determined to contribute to injury-related impairment and disability. This article represents the second part of a two-part review of MVCs and their consequences. In part I of the review, research findings related to physical, psychosocial, and cognitive changes that occur consequent to injury-causing MVCs are described. In this article, measures used to document the severity of physical injuries are reviewed, along with the most widely accepted definitions of impairment and disability. Models that have been proposed to explain the progression from injury to impairment and disability are reviewed, including a more recently proposed model created specifically to guide the assessment and management of MVC-related outcomes. The greater part of this article is devoted to the review of findings related to physical, psychological, and cognitive predictors of post-MVC impairment and disability. The relation of these predictors to post-MVC impairment and disability is described across three specific injury contexts: (1) whiplash-associated disorders, (2) traumatic brain injury, and (3) polytrauma. In each context, findings related to recovery of function in the form of return to work are summarized, along with findings related to the contribution of compensation to injury-related symptoms and impairments. Although not characterized as a physical injury, chronic pain serves frequently as the post-injury symptom that persists beyond all injury management and rehabilitation efforts and that contributes significantly to MVC-related functional impairment, disability, and emotional distress. It is appropriate, therefore, to include in this review a discussion of those MVC studies that specifically address impairment and disability occurring in relation to chronic pain. The article ends with the identification of ongoing research challenges and future directions for both the study of MVCs and their associated sequelae and clinical practice with persons who are experiencing the consequences of MVC-related injuries.     

Motor Vehicle Collisions and Their Consequences—Part 1: Common Physical,Psychosocial, and Cognitive Outcomes

Motor vehicle collisions (MVCs) have a significant impact on injured persons and society. MVCs generally result in property damage, but more serious MVCs often result in physical injuries that have significant physical, psychosocial, and cognitive consequences, all of which may result in long-standing functional impairment and disability as well as marked changes in quality of life. This article represents the first part of a two-part review of MVCs; the complex and interactive array of physical, psychosocial, and cognitive changes that occur consequent to injury-causing MVCs; and the person and environmental factors that best predict functional impairment and disability following an MVC. The current article provides an overview of the scope and significance of MVCs and summarizes the literature related to the physical injuries and the physical, psychosocial, and cognitive impairments that are most commonly experienced consequent to MVCs. Physical injuries reviewed in the current article include fractures, whiplash-associated disorders (WADs), traumatic brain injury (TBI), multiple traumatic injuries or polytrauma, and chronic pain conditions. These injuries and conditions are reviewed because of the relative quantity and quality of existing research related to these injuries and conditions. This article also provides a review of those psychological disorders that more commonly begin, recur, or are exacerbated in the aftermath of an MVC. The following psychological disorders are reviewed: posttraumatic stress disorder, complex posttraumatic stress disorder, major depressive disorder, somatic symptom disorder, and major neurocognitive disorder and mild neurocognitive disorder. Finally, this article ends with a brief discussion of changes in quality of life that can occur in relation to the physical injuries and psychological and neurocognitive disorders that are common consequences of MVCs. The final section of this article will serve to introduce part II of this review of MVCs and their consequences, in which predictors of MVC-related impairment and disability are discussed.     

An ethics ensemble: abortion, Thomson, Finnis and the case of the violin-player

Abstract.  This paper considers approaches to the ethics of abortion and putative links to "rights" debates. In particular, it revisits two papers on the topic from the early 1970's, written by Judith Jarvis Thomson and John Finnis respectively. Consideration of the discourse produced by these papers to some extent reveals the strategic importance of linguistic and conceptual organisation—the rhetorical forces underlying claims to disinterested, analytical standing. In particular, the paper reviews the practical ethics analogy proposed by Thomson; the deployment of "Hohfeldian" rights analysis by John Finnis, the link to the abortion debate and the broader implications of such deployment in its relation to current "rights" discourse.     

Adolescents with Psychopathic Characteristics in a Substance Abusing Cohort: Treatment Process and Outcomes

Psychopathy is a condition with important consequences both for individuals who experience it and for the communities in which they live. Although the assessment of psychopathy among adolescents remains controversial, some evidence suggests that the affective and behavioral traits of adult psychopathy begin to emerge in childhood (B. B. Lahey & A. Kazdin, 1990) and continue across the lifespan (A. E. Forth, S. D. Hart, & R. D. Hare, 1990). The present study used the Psychopathy Checklist: Youth Version (PCL:YV; A. E. Forth, S. D. Kosson, & R. D. Hare, in press) to retrospectively assess psychopathic characteristics, treatment process, and outcomes of 64 individuals referred for treatment to a substance abuse program for adjudicated adolescents. This study focused on the relationship between psychopathic characteristics and treatment process and outcome variables, including attrition rates, quality of participation, substance use throughout treatment, clinical improvement, and 12-month recidivism rates. Psychopathic characteristics were negatively related to treatment process and outcome variables, including attrition, participation, substance use, and clinical improvement. Psychopathic characteristics were positively related to the number of arrests in the 12 months following treatment completion. Implications for treatment and future research with adolescents displaying psychopathic characteristics are discussed.     

Twelve short tandem repeat loci Y chromosome haplotypes: genetic analysis on populations residing in North America

A total of 2443 male individuals, previously typed for the 13 CODIS STR loci, distributed across the five North American population groups African American, Asian, Caucasian, Hispanic, and Native American were typed for the Y-STR loci DYS19, DYS385a/b, DYS389I/II, DYS390, DYS391, DYS392, DYS393, DYS437, DYS438 and DYS439 using the PowerPlex Y System. All population samples were highly polymorphic for the 12 Y-STR loci with the marker DYS385a/b being the most polymorphic across all sample populations. The Native American population groups demonstrated the lowest genetic diversity, most notably at the DYS393 and DYS437 loci. Almost all of the 12-locus haplotypes observed in the sample populations were represented only once in the database. Haplotype diversities were greater than 99.6% for the African Americans, Caucasians, Hispanics, and Asians. The Native Americans had the lowest haplotype diversities (Apaches, 97.0%; Navajo, 98.1%). Population substructure effects were greater for Y-haplotypes, compared with that for the autosomal loci. For the apportionment of variance for the 12 Y-STRs, the within sample population variation was the largest component (>98% for each major population group and approximately 97% in Native Americans), and the variance component contributed by the major population groups was less than the individual component, but much greater than among sample populations within a major group (11.79% versus 1.02% for African Americans/Caucasians/Hispanics and 15.35% versus 1.25% for all five major populations). When each major population is analyzed individually, the R(ST) values were low but showed significant among group heterogeneity. In 692 confirmed father-son pairs, 14 mutation events were observed with the average rate of 1.57x10(-3)/locus/generation (a 95% confidence bound of 0.83x10(-3) to 2.69x10(-3)). Since the Y-STR loci reside on the non-recombining region of the Y chromosome, the counting method is one approach suggested for conveying an estimate of the rarity of the Y-haplotype. Because the Y-STR loci are not all in disequilibrium to the same extent, the counting method is a very conservative approach. The data also support that autosomal STR frequencies can be multiplied by the upper bound frequency estimate of a Y-haplotype in the individual population group or those pooled into major population groups (i.e., Caucasian, African American, Hispanic, and Asian). These analyses support use of the haplotype population data for estimating Y-STR profile frequencies for populations residing in North America.     

Challenges to the Recruitment and Retention of Volunteers in Traditional Nonprofit Organizations: A Case Study of Australian Meals on Wheels

Australian Meals on Wheels (MoWs) is a well-known, traditional nonprofit organization operating for over 60 years in a mixed economy of welfare, where it is positioned between the increasingly complex demands of state regulation and market efficiency. These contextual challenges cause critical tensions to an organization reliant on humanitarian principles and a large volunteer workforce. Findings show that this organization is experiencing conflicting and multiple identities which are having a significant impact on volunteer recruitment and retention. Specifically, data highlight the external challenges that threaten volunteers relating to regulation and funding, and internal challenges that tend to ignore volunteer value and instead picture volunteers as ageing and resistant to change. Findings suggest that the organization needs to work with all stakeholders to develop a shared organizational identity that blends humanitarianism with managerialism. New inclusive processes can enable better recruitment and retention practices, enabling the organization to “unfreeze” its traditional ways of operating to build a sustainable future for this much-needed organization.     

Layoffs in China's City of Textiles: Adaptation to Change

Urban poverty among laid-off workers has become one of the major challenges confronting China due to the massive retrenchment of state employees since the 1990s. While a great deal of research has focused on the general situation or the analysis of aggregate-level data, the workers themselves have been given much less attention. Based on data from Shaanxi Province, this paper examines the current status of the former state workers and their families in the once-prosperous “City of Textiles,” a district of state-owned textile mills and affiliated residential areas where the risk of slum development and marginalisation of former state workers has increased since economic reform. These textile workers had devoted themselves to hard work, acted as communist zealots and performed family duties at the same time, believing that the government would take care of their families. However, the poverty induced by the layoff programme has not only altered their lives and deteriorated intra-family relationships, but has also pushed some laid-off workers into various illegal activities to maintain household finances and to pay for rapidly rising tuition fees and medical expenses. We contest the commonly held view that poverty faced by former state workers is of their own making and show that current government anti-poverty strategies are inadequate to deal with the problem.