Sudden death owing to right atrial hemangioma

Primary cardiac tumors are rare, with an autopsy incidence of 0.03%. Seventy-nine percent to 85% of primary cardiac tumors are benign, and of the benign tumors, cardiac hemangiomas account for 5-10% of cases. Most cardiac hemangiomas are asymptomatic and are discovered incidentally at autopsy, or by echocardiography, computerized tomography, or magnetic resonance imaging. We report a case of sudden death owing to cardiac hemangioma in a 22-year-old woman who collapsed while shopping and became unresponsive. The autopsy revealed a hemorrhagic mass on the surface of the right atrium which was infiltrating and replacing the wall of the right atrium; histopathological examination confirmed the tumor was a cavernous hemangioma. Fewer than 20 cases of right atrial cavernous hemangiomas have been reported in English literature, emphasizing the rarity of our case.     

Fatality involving complications of bupivacaine toxicity and hypersensitivity reaction

This case represents unusual findings of elevated bupivacaine and tryptase concentrations following local anesthetic, bupivacaine, administered as a scalene nerve block for elective rotator cuff repair surgery. Following bupivacaine injection, the patient exhibited almost immediate seizure activity, bradycardia, and cardiac arrest. Resuscitative efforts including cardiopulmonary bypass restored a cardiac rhythm. However, the clinical medical status of the patient progressively declined and he died 7 h following administration of the local anesthetic. Autopsy revealed several abnormalities of the heart including cardiomegaly, myocardial bridging, and lipomatous hypertrophy of the intraatrial septum, which may have contributed to bradycardia and arrhythmia. Postmortem toxicology results revealed elevated bupivacaine and tryptase concentrations. Elevated postmortem bupivacaine concentrations 7 h following administration and abrupt onset of seizures indicate unintentional intravascular injection instead of nerve and tissue infiltration. An elevated postmortem tryptase concentration points to the possibility of a hypersensitivity reaction to bupivacaine.     

Domestic violence and sexual assault service goal priorities

We investigated agency directors' perspectives about how service goals should be prioritized for domestic violence and sexual assault service subtypes, including crisis, legal advocacy, medical advocacy, counseling, support group, and shelter services. A sample of 97 (94% response rate) North Carolina domestic violence and/or sexual assault agency directors completed a survey asking participants to rank the importance of service goals. Overall, participants considered emotional support provision to be a critical service goal priority across all service types. Social support and self-care service strategies were deemed less important. However, prioritization of other service goals varied depending on the service type. Statistically significant differences on service goal prioritization based on key agency characteristics were also examined, and agency characteristics were found to relate to differences in service goal prioritization.     

A False Sense of Security: Moral Panic Driven Sex Offender Legislation

Data collected from correctional files of sex offenders managed by the California Department of Corrections and Rehabilitation were analyzed to explore the degree to which sex offender behavior meets the assumptions of the legislation intended to regulate their behavior. The study asked where offenders commit their sex crimes and the likelihood of choosing a known vs. a stranger victim. The concept of moral panic is used as a framework to discuss possible motivations for current sex offender legislation.     

Insanity, methamphetamine and psychiatric expertise in New Zealand courtrooms

The use of methamphetamine in New Zealand has increased significantly over the last decade. Due to the potential of methamphetamine to induce, exacerbate and precipitate psychotic symptoms, this drug has also taken centre stage in several criminal trials considering the sanity of defendants. Highly publicised and often involving contested expert evidence, these criminal trials have illustrated the limits of using psychiatric expertise to answer legal questions. This article considers the implications of such cases in light of material from a qualitative study that aimed to generate insights into the difficulties forensic psychiatrists and their instructing lawyers face when providing expert evidence on the relationship between methamphetamine, psychosis and insanity. It reports material from 31 in-depth interviews with lawyers and forensic psychiatrists and observation of one criminal trial that considered the relationship between methamphetamine and legal insanity. The findings are correlated with the clinical and medico-legal literature on the topic and subjected to scrutiny through the lens of "sanism". The article concludes that the continued use of forensic psychiatry to meet the legal objectives of insanity, where methamphetamine is involved, has the potential to reinforce sanist attitudes and practices.     

Investigation of a typology of alcohol‐related violence defined by ultimate goals

Purpose. Alcohol‐related violence is a serious problem and treatments for high‐risk individuals need to be developed. Classification helps to route people into appropriate treatments. Drawing on animal research, we define alcohol‐related violence in relation to ultimate goals. We propose three types of violence: (1) violence in the pursuit of material goals, (2) violence in pursuit of social dominance goals, and (3) violence as defence in response to threat. The aim is to explore factors that we expect to relate to this tripartite typology, with the aim of providing a preliminary validation. Method. Participants were 149 young male prisoners who had committed an offence of violence that was alcohol related. Semi‐structured interviews elicited information about the offence that enabled classification into one of the three types. Differences between groups were examined at the event level – level of violence during the offence and alcohol consumption before the offence – and at group level – trait aggression, trait anxiety, anger control, and alcohol–aggression outcome expectancies. Results. No differences were found in levels of violence or alcohol consumption. Those whose violence was in the pursuit of material goals were high on trait aggression, trait anger, trait anxiety, and anger suppression. Those who used violence in the pursuit of social dominance showed high trait aggression and trait anger. Those whose violence was a defence in response to threat showed lower trait aggression and trait anger. Conclusion. The findings are discussed in relation to differential group profiles and treatment needs.     

Anxiety,alcohol intoxication,and aggression

Purpose. Research into alcohol‐related aggression has typically focused on perpetrators’ externalizing characteristics. The purpose of this exploratory review is to examine the contribution of anxiety to alcohol‐related aggression. Arguments. Anxiety disorders are associated with externalizing disorders in childhood, but anxiety appears to protect against extreme antisocial behaviours. In contrast, in adolescence and early adulthood, anxiety appears to be associated with increased risk of antisocial behaviour. One possible explanation for this disjunction may be alcohol use, which typically starts in adolescence. Alcohol is an anxiolytic drug, which may appeal to certain young people who are socially anxious but not socially avoidant. Alcohol myopia, the cognitive mechanism whereby alcohol exerts an anxiolytic effect, is also a mechanism by which alcohol serves to increase aggression. Therefore, in anxious antisocial people, drinking to cope with anxiety is likely to increase aggression. Conclusions. Interventions that flow from the research on anxiety, alcohol, and aggression are suggested.