The review panel process: an algorithm for the conditional release of insanity acquittees

The release of insanity acquittees requires making informed decisions regarding both the presence and severity of an individuals' mental illness and the dangerousness of these individuals. This study evaluated the usefulness of employing structured assessments of mental health and violence risk factors in the conditional release decision-making process. All persons found Not Guilty by Reason of Insanity at East Louisiana Mental Health System, Forensic Division who underwent a review panel between July 1, 1997 and July 1, 1999 were included in this study. The Classification and Regression Tree analysis was utilized to arrive at cutpoints that would optimize the predictive ability of the decision tree analysis. The results indicated that the Community Outpatient Treatment Readiness Profile score was the strongest predictor -- all patients receiving a score of 62 or greater on this scale were recommended to remain at the facility. When women were recommended for release, it was to civil facilities and with moderate levels of symptoms. For males with moderate symptoms, low PCL-R scores were associated with recommendations for release, whereas high scores were associated with recommendations for continued commitment. Our data suggests that algorithms may be useful to governing bodies when making release decisions.     

The role of beta-amyloid precursor protein (beta-APP) staining in the neuropathologic evaluation of sudden infant death and in the initiation of clinical investigations of subsequent siblings

This report highlights the importance of undertaking immunohistochemical staining of the brains of infants who die unexpectedly, as it may not only assist with the evaluation of the cause of death in an individual infant but may also help with the clinical management of subsequent siblings. A 5-month-old male infant who died suddenly was found to have diffuse beta-amyloid precursor protein (beta-APP) staining in the brain, with no unusual features in his history, death scene examination, routine autopsy dissection, and ancillary tests to suggest any definite cause of death. Due to the beta-APP staining, the possibility of previous episodes of occult trauma, apparent life threatening events (ALTEs), and accidental or inflicted suffocation was raised in the autopsy report. As detailed analyses and investigations provided no supportive evidence for trauma or inflicted injury, hypoxia was clinically considered the most likely cause. Because of these concerns, sleeping oxygen saturation levels were monitored following the birth of a subsequent sibling who had normal APGAR scores and no evidence of any health problems. Oxygen desaturation to 70% occurred in association with a color change while on the postnatal ward, and a subsequent polysomnogram showed multiple episodic significant desaturations to around 80% in association with central apnea. Other testing was unremarkable. These cases demonstrate that beta-APP staining of the brain may not only provide clues as to possible mechanisms of death in pediatric forensic cases but may indicate a need for careful clinical evaluation of subsequent siblings for possible central apnea requiring oxygen therapy.     

The Substitution Approach To Intergovernmental Relations: The Case Of OSHA

Federal legislation of the last two decades has substantiallyreduced state autonomy in dealing with many regulatory issues.Participation in the implementation of these federal programsmay, however, enable states to exert some leverage over policyoutcomes. Variations in state leverage no doubt exist from oneintergovernmental grant program to the next. Substitution authoritymay be one variable accounting for this variation. Under a substitutionapproach, a federal agency cannot only sever the flow of fundsto a grantee; it can also step in and operate a program if statesfail to meet expectations or choose not to participate. Thisarticle generates more basic propositions about the substitutionapproach by analyzing its implementation under the OccupationalSafety and Health Act of 1970. The article examines the roleplayed by substitution authority in motivating the OccupationalSafety and Health Administration (OSHA) to adopt an aggressiveposture toward the states. The article then assesses whetherOSHA's aggressiveness prompted state grantees to exert considerableeffort on behalf of program goals. Finally, the implicationsof current reform proposals, which call for a sorting out offunctions between the states and the federal government, receiveattention.     

Subgroup differences and implications for contemporary risk-need assessment with juvenile offenders

Risk-need assessment is widely accepted as best practice with juvenile offenders and is underpinned by a healthy research literature on risk assessment inventories. Previous studies have found both similarities and differences on risk measures when gender and racial/ethnic subgroups have been compared. Differential validity has been examined, but differential prediction has been overlooked. The current study undertook gender and ethnic comparisons for a large sample (n = 3568) of community-based juvenile offenders who were evaluated using the Australian Adaptation of the Youth Level of Service/Case Management Inventory (YLS/CMI-AA). Analyses showed various gender and ethnic differences at the item level, across domain scores and on the total inventory score, but not for validity indices. However, 1-year reoffending rates for youth in three classification categories (low, moderate, high) varied by gender and ethnicity. The findings were related to contemporary understandings of the risk factors for offending and the dynamics of crime for gender/ethnic subgroups. It is argued that in spite of these subgroup differences, a generic inventory such as the YLS/CMI-AA can be used fairly with various subgroups. Recommendations for how this could be accomplished are provided. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

A validated method for the analysis of cannabinoids in post-mortem blood using liquid-liquid extraction and two-dimensional gas chromatography-mass spectrometry

Phenazepam is a long-acting benzodiazepine that, unlike other benzodiazepines, is currently not scheduled as a narcotic in Finland, most other European countries or the USA. It is used as an anxiolytic, sedative-hypnotic and anti-epileptic, mainly in Russia. In Finland, as well as in some other countries, an increase in the unauthorized use of phenazepam has been observed in recent years. In the one year period between July 1, 2010 and June 30, 2011 the prevalence of phenazepam in Finland was assessed among drivers apprehended for driving under the influence of drugs (DUID), in medico-legal autopsy cases and in police confiscations of illicit drugs. In DUID cases an LC-MS/MS method preceded by solid phase extraction was used for the determination of phenazepam. In the post-mortem investigations the sample preparation consisted of liquid-liquid extraction followed by derivatization and the determination was carried out by GC-MS. The police confiscations were analysed by GC-MS. There were 141 positive phenazepam cases among apprehended drivers, representing approximately 3.5% of all confirmed drug cases (n=4007) in this time period. The median (range) phenazepam blood concentration in DUID cases was 0.061 mg/L (0.004-3.600 mg/L). The median phenazepam concentration in cases with no concomitant stimulant use was significantly higher than the overall median concentration. Phenazepam was found in 17 medico-legal autopsy cases and the median (range) blood concentration was 0.048 mg/L (0.007-1.600 mg/L). Phenazepam was not considered by the medico-legal team to be the sole cause of death in any of the cases, the majority of them being accidental opiod overdoses. There were 26 seizures of phenazepam by the Police in the time period studied, some of the batches consisted of a mixture of phenazepam and stimulant designer drugs. The data show that phenazepam abuse is a widespread phenomenon in Finland. A typical user was a male multi-drug user in his 30s. The concentration range of phenazepam among apprehended drivers and medico-legal autopsy cases was wide and the drug was usually found along with other psychoactive drugs. Therefore, although it seems likely that phenazepam contributed to impairment of driving in some DUID cases, the extent of its effect remains unclear and further studies are needed to define the concentrations causing impairment and toxicity.     

School-Based Group Interventions for Children Exposed to Domestic Violence

Children exposed to the trauma of domestic violence tend to experience difficulties with internalized and externalized behavior problems, social skills deficits, and academic functioning. Mental health practitioners in the school setting, including school counselors, school psychologists, and school social workers, can address developmental concerns that impede development through group counseling interventions that include both structured activities and play therapy. The school environment offers an ideal setting in which to work with child survivors of trauma, as all students have accessibility to school mental health resources. This article outlines the primary objectives and corresponding procedures for a developmentally- appropriate group interventions for elementary-aged children who have been exposed to the trauma of domestic violence.