Forensic Patients

Joos AA, Frank UG, Kaschka WP. Pharmacokinetic interaction of clozapine and rifampicin in a forensic patient with an atypical mycobacterial infection. J Clin Psychopharmacol 1998 18(l) 83-5. 

Becker, M. et al. (1997). Intractability is relative Behaviour therapy in the elimination of violence in psychotic forensic patients. Legal and Criminological Psychiatry 2 89-101. 

The newly revised Chapter 13 addresses security issues in emergency departments, pediatric locations, infant care units, medication storage locations, cUnical labs, forensic patient treatments areas, and behavioral units. The chapter also addresses communications, data infrastructure, and security of medical/health records. Chapter 13 covers media relations, crowd control, employee practices, and security operations. Facilities must conduct a security vulnerability analysis and planning for the protection of people and resources beyond a disaster event. Security education should address customer relations, emergency procedures, use of force issues, importance of effective de-escalation of tense tactics, and restraint usage. The new code reqnires the development of policies, plans, and procedures to address hostage situations, bomb threats, workplace violence, disorderly conduct, and restraining order policies. 

Forensic patients are common in general psychiatry, and will hone your risk assessment and management skills. Notice your anxiety levels they may alert you to an inpending risk event, or indicate you re holding too much responsibility yourself. If worrying a lot, take it to supervision. 

Some forensic patients spend long periods in prison or hospital, becoming institutionalised. This can make discharge particularly difficult for them, as they re used to the structure and routine of hospital. Discuss anxieties about leaving hospital with them before discharge, checking they feel adequately supported in case of fiiture problems. 

Risk assessment and information sharing with other agencies is key in managing forensic patients, but don t forget the basics. 

A comprehensive assessment of the stimulant-dependent patients psychological, medical, forensic, and drug use history may be difficult, because information may be incomplete or unreliable. In recognition of this deficiency, it is important that the patient receives a thorough physical examination, as well... 

In many industrial areas, as well as food and agriculture, the amount of sample available to the analyst is not normally a limiting factor. However, in clinical chemistry the opposite applies, as no patient is willing to donate large volumes of blood for analysis Similarly in forensic work, the sample material may also be limited in size. Sample size is linked to the limit of detection. Improved detection levels can sometimes be achieved by taking a larger mass of sample. However,... 

Pharmaceutical preparations, fluids, and powders taken from or found near a patient or body—so-called scene residues—which have forensic relevance. 

In my clinical and forensic experience, the emphasis on muscle rigidity is much too narrow. NMS can be accompanied by any kind of severe extrapyramidal reaction. Especially early in NMS, patients can display any of the wide array of neuroleptic-induced abnormal movements, including choreoathetoid movements, dystonia, and akinesia. Some cases look very much like severe TD, and often, the patients are left with persistent symptoms of TD. 

Recognition of antidepressant-induced maniclike reactions and akathisia in two of the most commonly used manuals of psychiatric diagnosis spanning 1993-2000 has important implications for clinical practice and forensics. Practitioners should be aware that these adverse drug reactions occur and that the patient should be diagnosed with... 

Electroshock specialists almost never seriously consider the memory deficits of their patients. In case after case that I have evaluated for clinical or forensic purposes, I have been the first doctor to take the symptoms seriously, let alone to take a complete inventory of memory losses and ongoing mental difficulties. I have previously outlined a method for evaluating memory deficits from ECT (Breggin, 1979). 

These advantages are important in treating particular groups of patients, including patients with brain injury, elderly people, forensic populations, and the medically ill (11,12). On the other hand, over 50% of patients with cerebellar ataxia reported significant adverse effects, as described above (SEDA-21, 39). 

Brewer, C., Hair analysis as a tool for monitoring and managing patients on methadone maintenance a discussion. Forensic Sci. Int., 63, 277,1993. 

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