Emerging problems for staff associated with the release of potentially dangerous forensic patients

Mental health professionals have been concerned recently about their liability for the actions of patients in their outpatient practices. The history of suits against clinicians for negligent release of inpatients extends back several decades since before the Tarasoff decision. The authors suggest that the same consumerism/victims' rights trends that resulted in Tarasoff and its progeny are likely to rebound again on forensic clinicians and that such pressures are likely to add to other political and social pressures that already complicate the treatment of forensic inpatients. They present three cases to illustrate the dilemmas involved in the release of forensic patients and argue that clinicians must bear significant responsibility for their current plight because of overstated claims of capacities to predict and treat aggressive behavior.     

Weal-formation by Utrica Dioica. An intravital reaction? (author's transl)]

The question concerning the intravital and postmortal mechanism of urticarial weal after contact with nettles (urtica dioica) was investigated in corpses, animal experiments and voluntary trials. No nettle weals could be induced in corpses or postmortally in experiments with albino rats (Witstar Strain). When animals were exposed to nettle-stings immediately before decapitation only 2 od 12 rats developed weals postmortally. However, the diameter of such weals was only 30% of that of weals produced intravitally. After Application of a tourniquet (180 - 200 mm Hg) to test persons no weals were formed after contact with nettles in a period of 10 minutes. As soon as the tourniquet was released weal-formation occured in full extent in most test persons. According to the authors opinion the occurence of nettle weals (urtica dioica) in corpses is therefore considered a local intravital reaction.     

Cyclizine as a drug of abuse?

Two British people going from Amsterdam to Berlin was examined at the borderline near Aix la Chapelle. Customsinspectors found besides a lot of hashish a letter hidden in a pocket lamp concerning drugs received in Amsterdam as remarks to LSD trips. Therefore a white powder found in a little paper in the purse of one person was tested for drugs. Previous examinations at the border failed and after further investigations at the Department of Forensic Medicine including mass spectrophotometry the powder was identified as Cyclizine. The analytical data like mass spectrum are described. This compound used many years for the prevention and treatment of motion sickness is off the market because of suggested teratogen effects. Previous reports about LSD-like symptoms after ingestion of large amounts of Cyclizine as the environment the powder was found let us suppose that some people will know about psychotic effects at high doses of this drug not being an inhibited narcotic.     

Black Esophagus: Acute Esophageal Necrosis in Fatal Haloperidol Intoxication

Herein, we present a case of 53‐year‐old psychotic woman with acute esophageal necrosis (black esophagus), who was found lying on the floor in the living room of her flat. Pillboxes of antipsychotic drugs were located in the bin. External examination of the body was unremarkable. On internal examination, we found acute esophageal necrosis. Histologically, there was complete epithelial necrosis with focal involvement of muscularis mucosae, dense infiltrate of leukocytes, and ulcerations without any viable cells. There was no evidence of underlying organic diseases or trauma. Toxicological analysis revealed a fatal blood level of antipsychotics (haloperidol, zotepine, and chlorprothixene). Death of the deceased was attributed to fatal intoxication with three various types of antipsychotics. As far we know, this is the first described association between so‐called black esophagus and fatal blood level of neuroleptics.     

Epiphyseal Union of the Cervical Vertebral Centra: Its Relationship to Skeletal Age and Maturation of Thoracic Vertebral Centra

Epiphyseal union stages for cervical vertebral centra (ring epiphyses) were documented for 55 individuals (females and males, ages 14–27 years) from the Terry Collection, using the Albert and Maples method 1, to examine both its relationship to age at death and to thoracic data collected from the same individuals using the same method. Results showed a moderate correlation between cervical ring union and age (r = 0.63, p = 0.000), and a fairly low correlation between cervical and thoracic ring union (r = 0.41, p = 0.002). Paired samples t‐tests yielded a statistically significant difference between cervical and thoracic union mean values (p = 0.01). Union progressed earlier in cervical vertebrae and in females. Results indicated fairly substantial variation in both sexes. Findings may serve as a basic guideline for estimating a general age range at death for unknown skeletal remains and to corroborate findings from other skeletal age indicators.     

Assessment of public attitudes towards sex offenders in an Australian population

Public attitudes towards sex offenders are believed to play a key role in the development of legislation and public policy designed to manage the risks posed by known sex offenders who live in the community. There have, however, been few previous attempts to validate methods by which public attitudes can be measured. The current study aims to address this issue by establishing the factor structure of the Community Attitudes Towards Sex Offenders (CATSO) scale with an Australian community sample and examine the extent to which demographic variables and support for sex offender management policies influence these attitudes. A sample of 552 participants recruited through online social media sites completed the CATSO as well as a number of items developed by the researchers designed to assess individuals' support for specific sex offender policies. Results of an exploratory factor analysis suggested the presence of four distinct factors which were labelled ‘social tendencies’, ‘treatment and punishment’, ‘crime characteristics’ and ‘sexual behaviour’. Individuals with higher levels of educational attainment rated sex offenders less negatively than those with lower educational attainment, while those who reported being supportive of community notification reported more negative attitudes towards sex offenders.