Neurocognitive Disorders in DSM-V: Forensic Perspective

Although determination of diagnosis of cognitive impairments constitutes one of the core objectives of forensic neuropsychological assessment, the diagnostic criteria for cognitive disorders provided by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, American Psychiatric Association 2000) have been of low internal and external validity and limited utility. This paper reviews the evolution of diagnosis of cognitive disorders from current DSM-IV-TR to the proposed DSM-V (American Psychiatric Association 2010). The conceptual framework is tracked, along with the body of literature associated with the DSM-V proposal on Minor and Major Neurocognitive Disorders. The quality of evidence for internal and external validity is reviewed, as well as the fairness and utility of newly proposed diagnoses from both clinical and forensic perspectives. Significant conceptual, evidentiary, psychometric, assessment, and practical questions are raised related to the new classification, and recommendations are offered for improvement to the proposal of the DSM-V Work Group on Neurocognitive Disorders.     

Expressions of IL -1α, IL -1β and IL -13 mRNA in Lung Tissue and Serum of Rats Drown in Fresh WaterCSCD

Objective: To detect the changes of (interleukin, IL)-1α, IL-1βand IL-13 mRNA in lung tissue and serum of drown rats, and to explore the potential value for the diagnosis of drowning in forensic practice. Methods: Eighteen SD rats were randomly divided into drowning group, blank control group and myocardial infarction group (as control group). The serum of right ventricular, the inferior lobe of right lung and the myocardium were taken from the rats in different groups. The expressions of IL- 1α, IL-1βand IL-13 mRNA in the lung tissue and the serum of right ventricular were detected by TaqMan probe method. Results: The expression differences of IL-1α, IL-1βand IL-13 mRNA in lung tissue between drowning group and blank control group, myocardial infarction group were not statistically significant (P>0.05). The expression of IL-1βand IL-13 mRNA in serum of right ventricular increased (P<0.05). The expression differences of IL-1α, IL-1βand IL-13 mRNA in serum between blank control group and myocardial infarction group were not statistically significant (P>0.05). Conclusion: The changes of cytokines IL-1βand IL-13 mRNA in the serum of right ventricular of drown rats are statistical significance, which are highly correlated with drowning. © 2018 by the Editorial Department of Journal of Forensic Medicine.     

Anoxia-Hypoxia in Forensic Neuropsychological Assessment: Cognitive Impact of Pulmonary Injuries,Respiratory Distress,Cerebral Blood Hypoperfusion,and Major Surgeries

Pulmonary injuries, respiratory distress, blood loss-related cerebral blood perfusion, and major surgeries are common features of medical histories in forensic neuropsychological assessments. Unless the explicit reason for referral is determination of the cognitive impact of one of these adverse medical conditions, their contribution to neuropsychological causality determination can be overlooked, minimized, or misattributed to other causes. Given the underlying common denominator among these conditions, that is, sub-optimal oxygen delivery to the brain, transient or long-term debilitating injuries causing neuropsychological change of various degrees can result. A thorough understanding of the impact of these medical events is paramount in forensic neuropsychological assessment for diagnosis, causality, and functional impact determination, prognosis, rehabilitation, and recommendations. In this paper, we critically review the available empirical evidence regarding anoxia and hypoxia arising from pulmonary injuries and respiratory distress, cerebral blood hypoperfusion, and major surgeries, together with evidence of their impact on cognitive functioning. Medical and psychological electronic search engines [PubMed, PsycINFO, and Google Scholar (up to January 2018)] have been screened for neuroscience-related and neuropsychological literature pertaining to pulmonary injuries and respiratory distress, cerebral blood perfusion, and major surgeries, and subsequently optimized for the issue under review.     

Commerce and institutions: Trade, scope, and the design of regional economic organizations

The design of current regional economic organizations (REOs) is remarkably diverse. Some REOs address numerous economic issues, while others have only limited mandates. Some REOs have an independent bureaucracy and a legalized dispute settlement mechanism (DSM), while others do not. What determines this institutional variation? Thinking about these institutions as devices that generate credible commitment to a rule-based regional cooperation, institutionalists maintain that the intensity of commercial ties determine regional institutionalization and institutional independence. A number of studies question this logic and argue that it is “naïve.” Empirical evidence on the links between commerce, economic scope, and regional institutions is scant, however. Using an original data set that contains detailed information on the economic activities and institutional structure of twenty-eight REOs over three decades, this paper presents one of the first systematic analyses of these relationships. The empirical analysis indicates that the institutionalist wisdom is right after all. It shows that higher levels of regional trade are associated with greater institutionalization and economic scope, but only if implementation of signed agreements is accounted for, and that regional commerce and greater economic scope are associated with more independent bureaucracies and more legalized DSMs.     

A rare case of lethal methadone intoxication of a 3-week-old infant

The authors describe a rare case of lethal methadone intoxication of a 3-week-old infant. Born of a drug-addicted mother who was undergoing methadone substitution therapy, the newborn presented withdrawal symptoms and was immediately admitted to a paediatric ward where it was treated for 3 weeks, without administration of methadone. The infant died during bottle feeding within 24 h following discharge home.A post-mortem examination was performed as well as histopathological, toxicological and genetic tests were carried out in order to establish the cause and mode of death.The autopsy revealed obstruction of the lower air passages by stomach contents along with classical features of asphyxia. Toxicological tests revealed high concentrations of methadone and its metabolite in blood and urine as well as presence of methadone in stomach contents, and the DNA polymorphism analysis of the (sex-specific) amelogenin locus gave a negative result.On the basis of the results of the post-mortem examination, the laboratory tests and the police investigation, it was concluded that the drug was ingested with the bottle milk, and the possibility of administration of methadone at the hospital or its ingestion with the breast milk was precluded. Though both the cause and mode of death were established, the public prosecutor discontinued proceedings in the case due to inability to find the perpetrator.     

Identification and analyses of female civilian victims of the 1991 war in Croatia from the Glina and Petrinja areas

Introduction

The process of recovering and identifying human remains from individual and mass graves has proven to be the most effective method of resolving the fate of missing individuals in the former Yugoslavia. These efforts have two primary objectives: medicolegal—to identify the cause of death, and humanitarian—to bring closure to living family members, thus supporting the human rights of both the living and the deceased. From 1996 to the present, the remains of 388 individuals killed during the 1991 War in Croatia were recovered from the Glina and Petrinja areas (Sisa?ko–Moslova?ka County). The purpose of this paper is to report on the demographic and taphonomic characteristics of the recovered remains, and identify factors responsible for the discrepancy in the identification ratios.

Methods

To identify factors potentially responsible for the noted discrepancy, data were collected on the taphonomic characteristics of the recovered remains, the types of burials, as well as the factors responsible for positive identification. These factors included: forensic DNA testing, dental criteria, special signs (healed fractures, etc.), clothing and personal artifacts.

Results

The age distributions between males and females in the sample are significantly different. The mean age-at-death for males is 51.6 years, for females 67.0 years. In both sexes the majority of identifications (62.9% in females and 45.9% in males) were established through a combination of biological and non-biological features. In terms of the types of graves from which the bodies were recovered, positive identification in both sexes was lowest in mass graves (61.2% for males, and 84.2% for females). Females from mass graves were, however, better preserved than males—36.6% of males recovered from mass graves were completely skeletonized, while the same was true for only 19.3% of females (χ² = 7.06, P < 0.029). Completely skeletonized remains were identified in only 65.1% of cases, while partially skeletonized and saponified bodies were identified in 80.1% of cases.

Conclusion

Since positive identification in both sexes is strongly correlated with preservation of the bodies, the reason why female identification frequencies in the Glina and Petrinja regions are higher than male frequencies lies in the fact that females recovered from mass graves were better preserved than males recovered from mass graves. Identification of the factors responsible for this is a challenge that needs to be resolved in future studies.     

The chemical interconversion of GHB and GBL: forensic issues and implications.

In this work, the interconversion of GHB and GBL in a variety of aqueous media was studied. The effects of solution pH and time were determined by spiking GHB or GBL into pure water and buffered aqueous solutions, and determining the GHB and GBL contents at various time intervals. The degree of GBL hydrolysis to GHB was determined for several commercial aqueous-based GBL products, and further studied as a function of time. The effects of temperature and time were also determined for five commercial beverages spiked with GHB or GBL. GHB and GBL contents were determined using high performance liquid chromatography (HPLC). GHB and/or GBL confirmations were made using gas chromatography-mass spectrometry (GC-MS) and/or infrared spectroscopy (IR). Solution pH, time, and storage temperature were determined to be important factors affecting the rate and extent of GBL hydrolysis to GHB. Under strongly alkaline conditions (pH 12.0), GBL was completely converted to GHB within minutes. In pure water, GBL reacted to form an equilibrium mixture comprising ca. 2:1 GBL:GHB over a period of months. This same equilibrium mixture was established from either GHB or GBL in strongly acidic solution (pH 2.0) within days. A substantial portion of GBL (ca. 1/3) was hydrolyzed to GHB in aqueous-based GBL products, and in spiked commercial beverages, after ambient storage for a period ranging from several weeks to several months. Heat increased and refrigeration decreased the rate of GBL hydrolysis relative to ambient conditions. These studies show that hydrolysis of GBL to GHB does occur in aqueous-based solutions, with samples and time frames that are relevant to forensic testing. Implications for forensic testing and recommendations are discussed.     

Beyond Traumatic Brain Injury: Advancing Forensic Neuropsychological Assessment

As research on the cognitive impact of medical conditions and mental health disorders advances, it is imperative for forensic neuropsychologists to stay abreast of rapidly accumulating new empirical evidence from neuroscience and neuropsychology to disentangle multiple determinants of cognitive impairment. Although medicolegal neuropsychological assessments traditionally focused on traumatic brain injury (TBI) sequelae, it is equally important to consider the potential impact of any other acquired, or secondarily induced brain impairments, regardless of their source. Such injuries or conditions are at times assumed to cause a lesser cognitive impact than TBIs; however, their effects depend entirely on the factor in question. Injuries and illnesses implicated in civil litigation—and eventually affecting competency—can indeed involve TBI, but also anoxic/hypoxic injuries, pain, depression, posttraumatic stress disorder (PTSD), sensory deficits (e.g., tinnitus), and fatigue, and all, in turn, can affect an individual’s cognitive function and quality of life. Impairments caused by these conditions can be disabling and resistant to treatment, particularly, when the treatment is based on incorrect diagnostic, prognostic, and causality assumptions.     

Paolo Zacchia--the father of forensic medicine, 400 years after his birth

This article was the historical introductory lecture in the opening session of the Annual Meeting of the Polish Society of Forensic Medicine and Criminology held on 20 September 1984, in Katowice. Paolo Zacchia (1584-1659) was one of the fathers of forensic medicine and social hygiene, which were combined in his time. His work Quaestiones medico-legales is well known internationally.