Psychiatric Patients’ Comprehension of <Emphasis Type="Italic">Miranda</Emphasis> Rights

Seventy-five psychiatric inpatients were evaluated with respect to their Miranda-related abilities using Grisso’s (1998, Instruments for assessing understanding and appreciation of Miranda rights. Sarasota, FL: Professional Resource Press) instruments and Goldstein’s (2002, Revised instruments for assessing understanding and appreciation of Miranda rights) revision to determine: whether different versions of Miranda warnings translate into differences in understanding; the influence of psychiatric symptoms, diagnostic categories, and IQ upon Miranda comprehension; and the relative performance of persons with psychiatric impairment on Miranda-relevant abilities. Results indicated that although the Miranda language used in Goldstein’s revision generally showed lower grade reading levels and higher reading ease scores than Grisso’s original instruments, this did not translate into improved understanding. In addition, psychiatric symptoms were negatively correlated with Miranda comprehension, even after controlling for IQ. Finally, results revealed that psychiatric patients’ understanding and appreciation was substantially impaired compared to Grisso’s adult validation samples, and was roughly comparable to Grisso’s juvenile validation sample. Implications of these results for policy reform are discussed.

Burden of Neurodegenerative Diseases in a Cohort of Medical Examiner Subjects*

Abstract: Here we report studies of the burden of neurodegenerative neuropathologies in a cohort of Medical Examiner (ME) subjects from the County of Santa Clara (California) to determine if this unique population of decedents manifested evidence of neurodegeneration that might underlie causes of death seen in an ME practice. We found that 13% of the brains from ME cases showed significant tau pathology, including 55% of those 65 years old and older and 63% of those 70 years old and older. The histochemical and immunohistochemical findings were consistent with Alzheimer’s disease (AD) in 7 subjects and frontotemporal lobar degeneration (FTLD) tauopathy type in six cases. There were no cases of Parkinson’s disease, dementia with Lewy Bodies or other neurodegenerative conditions. Our study suggests that decedents >65 years of age in an ME practice are afflicted by common causes of dementia such as AD and FTLD which could contribute wholly or in part to their causes of death.     

Inaction,under-reaction action and incapacity: communication breakdown in Italy’s vaccination governance

This article explores why governments do not respond to public compliance problems in a timely manner with appropriate instruments, and the consequences of their failure to do so. Utilising a case study of Italian vaccination policy, the article considers counterfactuals and the challenges of governing health policy in an age of disinformation. It counterposes two methods of governing vaccination compliance: discipline, which uses public institutions to inculcate the population with favourable attitudes and practices, and modulation, which uses access to public institutions as a form of control. The Italian government ineffectively employed discipline for a number of years. Epistemological and organisational constraints stymied its efforts to tackle a significant childhood vaccination compliance problem. With a loss of control over the information environment, vaccinations were not served well by exogenous crises, the sensationalism of the news cycle and online misinformation. Hampered by austerity, lack of capacity and epistemic shortcomings, the Italian government did not protect the public legitimacy of the vaccination programme. Instead of employing communications to reassure a hesitant population, they focused on systemic and delivery issues, until it was too late to do anything except make vaccinations mandatory (using modulation). The apparent short-term success of this measure in generating population compliance does not foreclose the need for ongoing governance of vaccine confidence through effective discipline. This is evident for the COVID-19 vaccination campaign, with many Italians still indicating that they would not accept a vaccine despite the devastation that the disease has wrought throughout their country.

     

The Density of State Interest-Communities: Do Regional Variables Matter?

To better understand state interest-group politics, this studycompares two approaches to understanding the density of theirinterest communities. The first approach—Gray and Lowery'senergy, stability, area model of density—emphasizes asmall set of political and economic variables operative withineach state in accounting for density. The second, of which thereare several examples, emphasizes a regional level of analysis.The two approaches are evaluated as both independent and complementaryaccounts of state interest-community density using 1990 statelobby-registration data. Although some evidence of modest underspecificationin the Gray and Lowery model is found, regional or spatiallybased variables only have a small impact on the density of stateinterest-communities.     

Predictor Variables in Competency to Stand Trial Decisions

Clinicians possess significant discretion in competency to stand trial assessment. Therefore, it is paramount to explore the contribution of individual variables to ensure that the decision-making process is devoid of bias and solely relates to the legal criterion. To test for the possibility of bias in clinical decision-making, we examined the predictive efficiency of clinical, criminological, and sociodemographic variables in a sample of 468 criminal defendants referred for competency evaluations. Only clinical diagnostic variables and employment status were significant predictors. This finding supports the idea that examiner decisions of competency appear to be unbiased and relate primarily to a defendant's functional ability.     

Y-chromosome STR haplotypes in two population samples: Azores Islands and Central Portugal

The Y-chromosome haplotypes defined by nine STRs (DYS19, DYS385, DYS389I, DYS389II, DYS390, DYS391, DYS392 and DYS393) were studied in 207 unrelated individuals from Central Portugal and 63 from Azores Islands. The most common haplotype in Central Portugal was shared by 3.4% of the males, while 160 haplotypes were unique. In Azores Islands the most common haplotype was shared by 6.4% of the males, while 40 haplotypes were unique. The values of haplotype diversity were 0.993 for Central Portugal and 0.976 for Azores Islands.     

Putting community risk in perspective: a look at correlations, causes and controls

Much research, but not all, appears to show that persons with severe mental illness are more dangerous and violent than others; but it is misleading and feeds the stigma cannon. This paper critically reviews reported correlations between severe mental illness and violence, examines their statistical confounds, highlights studies which seek causal mechanisms explaining the associations, points to what those causal mechanisms tell us about controlling risk in the community, and reviews legal attempts to control community risk in light of those causal mechanisms.     

PLC or TLC: is outpatient commitment the/an answer?

The lively debate over mandated community treatment in general and outpatient commitment laws (OPC) in particular has raised many issues. At its core, the debate is over how and to what extent laws should be formulated to persuade, leverage or coerce (PLC) persons with severe mental illness living in the community to comply with medications that mental health professionals believe they need. The alternative to PLC is what we call TLC (tender loving care): a strategy of using benefits - improved patient-centered treatment, entitlements and service delivery, including assertive outreach - rather than penalties or conditions on access to services, to induce compliance. We examine three aspects of the debate: (1) the empirical case for the need for OPC court orders to maintain revolving-door severely mentally ill persons in the community; (2) the normative argument over whether such orders constitute coercion, and, if so, whether that coercion is justifiable; and (3) the incentives such orders create to leverage community providers to augment resources and tailor treatment and services to entice patients to become willing participants in the management of their disorders.     

An attempt to reduce guessing behavior in children's and adults' eyewitness identifications

The effects of age of witness, gender of witness, lineup presentation, and practice on eyewitness testimony were investigated. Ninety-six elementary-school children and 96 college students viewed a slide sequence of a crime, followed by target-present or target-absent photo identification in sequentially or simultaneously presented lineups. Prior to photo identification, half the subjects received a practice lineup. Children had a higher rate of choosing than adults, resulting in more foil identification errors in both target-present and target-absent lineups. Without prior practice, sequential presentation as compared to simultaneous presentation reduced errors in target-absent lineups for adult witnesses and showed a similar but nonsignificant reduction for child witnesses. With prior practice, sequential presentation lost the advantage over simultaneous presentation in target-absent error reduction. Practice reduced target-absent errors in simultaneous-presentation lineups for both age groups.     

Juvenile diversion and the constitution

The juvenile justice system has been a product of interaction between legal and socio-medical forces since its inauguration near the end of the last century. While the socio-medical forces have, for the most part, been dominant over the years, concern for minimum legal standards has been a conspicuous part of the picture since the years 1966 to 1967. The result is serious attention to due process and fundamental fairness in court processing, and low tolerance for abridgement of such rights in the interests of attaining the social goal of rehabilitation. The question arises as to how early in the procedural chain for juveniles various due process rights should enter. Some have argued that important due process rights should be components in the process leading to probation, and even police, diversion. The central argument of this article is that broad directives regarding due process in diversion are inappropriate. Indeed, analysis of actual and potential losses of freedom associated with diversion decisions leads to the general conclusion that very few diversion programs require usual procedural rights. Moreover, a survey of case law indicates that there is little reason to expect that the procedural protections enunciated by the U.S. Supreme Court so strongly in the 1960s will be extended by the courts to police (or probation) decisions on diversion in the 1980s.