Partial Agonist Therapy in Schizophrenia: Relevance to Diminished Criminal Responsibility

Abstract: Pathological gambling (PG), classified in the DSM‐IV among impulse control disorders, is defined as inappropriate, persistent gaming for money with serious personal, family, and social consequences. Offenses are frequently committed to obtain money for gambling. Pathological gambling, a planned and structured behavioral disorder, has often been described as a complication of dopamine agonist treatment in patients with Parkinson’s disease. It has never been described in patients with schizophrenia receiving dopamine agonists. We present two patients with schizophrenia, previously treated with antipsychotic drugs without any suggestion of PG, who a short time after starting aripiprazole, a dopamine partial agonist, developed PG and criminal behavior, which totally resolved when aripiprazole was discontinued. Based on recent advances in research on PG and adverse drug reactions to dopamine agonists in Parkinson’s disease, we postulate a link between aripiprazole and PG in both our patients with schizophrenia and raise the question of criminal responsibility.     

Suicide by skull stab wounds: a case of drug-induced psychosis

Suicide by stabbing to the head and/or driving sharp objects into the skull is of extreme rarity. This article reports the case of a 27-year-old man, who committed suicide by multiple knife stabs and cuts to the head, the torso, one shoulder and the forearms. Autopsy showed a perforating wound of the skull and the 10-cm long broken blade of the knife being still embedded in the right temporal lobe of the brain. The deceased had no history of psychiatric illness but was currently treated by mefloquine, a quinine derivative associated with a high rate of psychiatric adverse effects. Toxicological examination confirmed a recent intake of mefloquine together with chloroquine, another antimalarial drug. To our knowledge, this is the first report of a completed suicide with very strong evidence of mefloquine implication. Discussion focuses upon mefloquine-induced psychiatric disorders and highlights the importance of performing toxicological investigations in cases of unusual suicides.     

Post-mortem pregnancy: a proposed methodology for the resolution of conflicts over whether a brain dead pregnant woman should be maintained on life-sustaining treatment

In this article, the author examines conflicts over whether to maintain a brain dead pregnant woman on life-sustaining treatment. The author cautions that on the rare occasions when courts are confronted with such a conflict, they should employ a consistent methodology for resolution of the conflict and attempt to honor the wishes of the post-mortem mother and her family. The author draws on relevant areas of law to demonstrate the existence of a legal fiction that protects the interests of post-mortem pregnant women in refusing medical treatment. This article then proceeds to propose a methodology that enables courts to account for a post-mortem pregnant woman's interests, her family's interests, and the state's interests in resolving conflicts over whether to remove a post-mortem pregnant woman from life-sustaining treatment.     

The Treatment Engagement Rating scale (TER) for forensic outpatient treatment: Description,psychometric properties,and norms

Abstract

The Treatment Engagement Rating scale (TER) is a Dutch therapist rating instrument for treatment engagement (TE) of forensic outpatients. It yields scores for nine components of TE, which are aggregated in a total score. Following an analysis of the concept of TE, the TER is described, and various psychometric analyses of data from a forensic outpatient sample are reported. The nine component scores were found to constitute a homogeneous scale with good internal consistency (α=0.93, n=328) and adequate inter-rater reliability (intraclass correlation coefficient (ICC)=0.76, n=99). The validity of the TER is supported by correlations of 0.47, 0.66, and 0.91 (n=328) with measures for the motivation to engage in treatment. Applications for the TER in clinical practice and research are suggested.     

Accuracy,confidence and consistency in repeated recall of events

Abstract

In legal practice, both confidence and consistency of the testimony of eyewitnesses are often used as indicators for accuracy, but their usefulness has been questioned. The present study was designed to determine the relationship between accuracy, confidence and consistency in episodic memory. After viewing a video of a complex series of events, one group of participants was given an initial cued recall test after one week, and repeated recall tests after three and five weeks. A second group of participants was tested after three and five weeks, and a third group was tested only once after five weeks. Accuracy and confidence (at least for incorrect answers) decreased with longer initial retention intervals, but there was no decrease in either accuracy or confidence when recall was repeated. Repeated testing also did not lead to confidence inflation. Correlations between accuracy, confidence and consistency varied from medium to large. Inconsistencies were mainly caused by forgetting and reminiscence. These inconsistencies were recalled almost as accurately as consistently recalled information.     

Children in the environment: Forest day-care centers

Some features of early child care are more prominent in Norway than in other countries, such as emphasis on the outdoor environment. Of general relevance and interest is the form of day care provided by forest day-care centers. Three ideas form the development of these centers placed in wild areas. First, throughout history, Norwegians have had a close attachment to nature and some parents want to provide their children with outdoor experiences at an early age. Second, urging children to play outdoors characterizes the image many parents have of a happy, healthy childhood. Third, provision of day care for children has always been restricted in western countries, forcing parents to invent types of service that can become part of an ecological system that promotes healthy development.

The forest day-care centers developed recently represent a supplement to the wide typology of child care in the 21st century. The article outlines the connections between these ideas in general European and western history and Norwegian history and presents debate and decisions about a question dating from the last half of the 1980s. It concludes that the forest day-care centers are perhaps only a modern form of the original kindergarten concept, which started in Europe and America as gardens for children not gardens of children.     

Working on the Ground. A Collective Biography of Feminine Subjectivities: Mapping the Traces of Power and Knowledge

In this paper we map the traces of power and knowledge as we read them at play in our own memories and as we make sense of them from a Foucauldian perspective. Our question here is twofold: how might we use Foucault to read our embodied memories of power and knowledge; and how might we use the analysis of those stories to enable us better to see the implications of Foucault's writing for the analysis of subjects' enmeshment in power/knowledge relations? We use as the ground of our analysis our own embodied memories of achieving ourselves as appropriate(d) subjects (as girls and women, in relation to men--fathers, lovers, and husbands). Our trajectory in this paper is double. First, it has been towards uncovering the ways in which girls and women might be said to be powerful, even when they are complicit in their own subjection. Second, it has been to show that when Foucault defines all acts of power to involve the possibility of resistance and freedom, and he takes the opposite, a state of domination, to arise from 'economic, political, or military means', he has not fully acknowledged the extent to which the repeated, minute accretions of everyday practices can generate sedimentations of lines of force that may also be understood as a state of domination.     

Performance Contracts and Goal Attainment in Government Agencies

ABSTRACT

Public sector reforms introducing performance contracts provide a unique opportunity to investigate goals set for government agencies and factors affecting goal attainment. The article maps the set of goals contained in performance contracts for Danish government agencies in 2000, 2005, and 2008. Performance contracts are found to reflect the complex character of agency goals with performance goals ranging from project initiation to reducing case work time or increasing productivity. The article also analyzes factors affecting goal attainment. Agencies with a large percentage of goals focused on project initiation and production exhibit higher levels of goal attainment. Also, goal attainment improves as agencies and ministries gain experience with performance contracts.

For practitioners, it is relevant that contracts target a wide variety of goals and over time focus increasingly on results. Contracts serve to focus agency attention as three quarters of all demands are met. A crucial factor seems to be whether agencies are in control of formulating and meeting goals. Efforts to improve the contract regime may thus concentrate on enabling government departments to secure ambitious and relevant performance goals.     

Foreign aid: An instrument for fighting communism?

In this paper, we test the argument that the sizeable reduction in aggregate aid levels in the 1990s was due to the end of the Cold War. We test two different models using a dynamic econometric specification on a panel of 17 donor countries, spanning the years 1970–97. We find aid to be positively related to military expenditures in the former Eastern Bloc during the Cold War, but not in the 1990s, suggesting that the reductions in aid disbursements are driven by the disappearance of an important motive for aid. We also study the effect on aid allocation, but here we do not find any robust effects of the end of the Cold War.