Failure of a patient to awaken promptly after use of general anesthesia may be due to various causes, including medication-related effects, neurologic insults, or metabolic disturbances. Herein we describe a 49-year-old woman with a history of depression, for which she was receiving treatment, who did not awaken promptly after use of general anesthesia for ethmoidectomy. Results of neurologic examinations were normal, as were laboratory tests and radiologic studies. Six hours after completion of the operation, the patient spontaneously awakened. We hypothesize that she underwent a transient, self-limited period of dissociation related to unresolved grief due to the recent death of a family member.
Psychiatric and psychological assessment of criminal defendants is often complicated by the retrospective nature requiring (1) an overreliance on self-reported data and (2) the need to achieve a high degree of certainty in formulating the diagnosis and subsequent expert opinion within the context of an adversarial evaluation. The Multiple Schedule of Affective Disorders and Schizophrenia (SADS) evaluation involves the application of an extensive diagnostic interview that has demonstrated a high degree of reliability and satisfactory validity in making current and lifetime diagnoses. The multiple SADS entails sequential administrations of the SADS, first to the defendant and later to significant others regarding the defendant's functioning during the time period in question. This comprehensive approach allows for the systematic examination of individual symptoms and the clear delineation of disparities and areas of agreement. Usefulness of the multiple SADS evaluation is exemplified in a case study involving criminal responsibility.
Recognition of pathological gambling as a diagnostic and clinical entity has been paralleled by its use as an insanity defense by gamblers engaged in criminal behavior. The societal ramifications of exculpation for crimes committed by volitionally impaired defendants require a critical analysis of the relationship between mental illness and criminal acts. Following a summary of current knowledge about pathological gambling as a clinical disorder, case law relevant to its use as an insanity defense is reviewed. It is argued that pathological gambling is not a serious mental illness for the purposes of the criminal law and that it bears no causal relationship to criminal activity. Legal and societal interests dictate that pathological gambling be excluded as a potential insanity defense.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.