Forensic neuropsychiatry

Current Opinion in Psychiatry

Volumn 10, Issue 1, 1997, Pages 63-67

  Restak, Richard M ^a  

^a GEORGE WASHINGTON UNIVERSITY MEDICAL CENTER   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

BRAIN DISEASE; BRAIN DYSFUNCTION; DELUSION; FRONTAL LOBE; HUMAN; NEUROPSYCHIATRY; OFFENDER; RESPONSIBILITY; SHORT SURVEY;

EID: 0031016688     PISSN: 09517367     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001504-199701000-00014     Document Type: Short Survey

References (19)

1. Finkel NJ: Insanity on trial. New York: Plenum Press; 1988:16-22.
2. Ciccone JR: Murder, insanity and medical expert witnesses. Arch Neurol 1992, 49:609.
3. Freeman W, Watts JW: Psychosurgery: intelligence, emotion and social behaviour following prefrontal labotory for mental disorders. Springfield, Illinois; Charles C Thomas:1942.
4. Calev A: Pyromania and executive/frontal dysfunction. Behav Neurol 1995, 8:163-167 Deficits observed on neuropsychological tests suggest a form of dementia of the frontal type, suggesting that brain pathology may exacerbate pyromania.
5. Goldberg E, Podell K: Lateralization in the frontal lobes: searching the right (and left) way. Biol Psychiatry 1995, 38:569-571 These authors examined the relationship between hemispheric specialization and frontal lobe function, and suggested that much can be learned about the frontal lobe by contrasting cognitive activation tasks involving decision making guided by working memory versus decision making guided by long term knowledge.
6. Nichelli P, Grafman J, Pietrini P, Clark K, Lee KY, Miletich R: Where the brain appreciates the moral of a story. Cogn Neurosci Neuropsychol 1995, 6:2309-2313. This group drew a distinction between hierarchical semantic associative encoding subserved by the left hemisphere and thematic coding found in the right hemisphere. The researchers defined these differences through positron emission tomography scan studies and discovered that the human prefrontal cortex is dedicated to many aspects of story processing, including grammatical appropriateness and semantic interpretation, and is particularly well suited to appreciating the moral of a story.
7. Jibiki I, Kagara Y, Kishizawa S, Kurokawa K, Fukushima T, Furuta H, Yamaguchi N: Case study of monosymptomatic delusion of unpleasant body odor with structural frontal abnormality. Neuropsychobiol 1994, 30:7-10.
8. Wren C: Experts say plot suspect showed signs of torture. New York Times 1996, Aug 23:B2 This short piece in the New York Times is an important illustration of the types of problems that can result when the neuropsychiatrist overextends his or her knowledge base. Based on the fact that a defendant showed signs of post-traumatic stress disorder, a neuropsychiatrist expressed the opinion that the individual had been 'tortured'. Torture is, of course, only one of many possible etiologies for a post-traumatic stress disorder and it would not be possible to reach such a conclusion based simply on findings compatible with the DSM-IV diagnosis of post-traumatic stress disorder. This report is also important in terms of the increasing demand that neurologic and psychiatric organizations exert some degree of self-policing over whether an expert's testimony is responsible and consistent with accepted neuropsychiatric knowledge and principals.
9. Schindler BA, Ramchandani D, Matthews M K, Podell K: Competency and the frontal lobe. Psychosomatics 1995, 36:400-404. This paper is important because it illustrated that many of the bedside tests for competency may miss serious impairments of frontal function. The patients described by Schindler et al. appear intact in court, show verbal fluency, relatively intact memory; however, they have impairment of decision making capacity because of frontal lobe-executive dysfunction.
10. McKee GR: Insanity and adultery: forensic implications of a divorce case. Psychol Rep 1995, 76:427-434. The author illustrates the potential applications of neuropsychiatric findings. In this case, a divorce proceeding was turned on the determination of an automatism and whether the individual's behavior was under her conscious voluntary control or impaired by mental disorder. This case report may serve as a bell weather of forthcoming applications of neuropsychiatric findings.
11. Relkin N, Martell D, Mayberg H, Brakel S, Gonzalez ER Cavanaugh J, Weiss Z, Dauer R, Morse S: Semin Om Neuropsychiatry 1996, 3. This examination in detail of a single case study of a large arachnoid cyst centered in the left sylvian fissure facing the ventral frontal, anterotemporal and insular cortical gyri, is unique because of the contributions of many of the principal consultants and experts in the case, as well as additional experts drawn from neurology, psychiatry and the law.
12. Weiss Z: The legal admissibility of positron emission tomography scans in criminal cases: people v. Spyder Cystkopf. Semin Clin Neuropsychiatry 1996, 3:202-210. This paper, authored by the district attorney who prosecuted the case, illustrates the complicated issues involved when tests such as positron emission tomography scans, which remain predominantly experimental, are introduced into judicial proceedings.
13. Relkin N, Plum F, Miller F, Mattis S, Eidelberg D, Tranel D: Impulsive homicide associated with an arachnoid cyst and unilateral frontotemporal cerebral dysfunction. Semin Clin Neuropsychiatry 1996, 3:172-183 This group presents in detail the patient's course, from the commission of the crime up to his plea bargaining. It involves detailed discussion of the application of neuropsychiatric findings to the determination of guilt or innocence.
14. Brakel SJ, Gonzalez ER, Cavanaugh JL: Neuropsychiatry at the courtroom gates: selective entry or anything goes? Semin Clin Neuropsychiatry 1996, 3:215-221 The authors concluded that neuropsychiatrists should continue to work together with lawyers and lawmakers to ensure the appropriate application of emerging technology to legal proceedings.
15. Martell DA: Causal relation between brain damage and homicide: the prosecution. Semin Clin Neuropsychiatry 1996, 3:184-194. The neuropsychologist details why, in his opinion, the accused was not suffering from a mental disease or defect, and that he was able to appreciate right from wrong at the time of the homicide.
16. Dauer R E: Evidentiary admissibility of evidence of neurodiagnostic testing showing frontal brain lesion as a defense in a criminal homicide trial. Semin Clin Neuropsychiatry 1996, 3:211-214. This President Judge discusses why the doctrine of diminished capacity be kept within bounds by employing strict standards of relevancy when ruling on the admission of expert testimony and the admission of neuroradiologic tests.
17. Morse S J: Brain and blame. Semin Clin Neuropsychiatry 1996, 3:222-235. A scholarly discussion of the concept of the person and its relation to responsibility and excusing conditions. It demonstrates that causation of behavior in general, even pathological biological causation, is not in itself an excuse and suggests that the incapacity for rationality is a genuine basis of moral and legal excuse.
18. Mayberg H S: Medical-legal inferences from functional neuroimaging evidence. Semin Clin Neuropsychiatry 1996, 3:195-201. The author concluded that the use of scan abnormalities as the primary objective evidence of injury or disability is still anecdotal, and has not been validated by controlled studies. Until then, when asked to provide definitive conclusions with at least 'reasonable medical certainty', experts are in a scientifically, legally and ethically insupportable position, except in the most limited clinical situations.
19. Restak RM: Brain damage and legal responsibility Semin Clin Neuropsychiatry 1996, 3:170-171. A discussion of why neuropsychiatric determinations in a courtroom are fraught with social, moral and even political considerations. One source of difficulty stems from the difference between what lawyers and judges accept as proof compared with the more empirical approaches of the neuropsychiatrist.