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Strontium90 for determination of time since death
262
Journal of Clinical Forensic Medicine
psychiatrists may fully participate in the debate and aid the court in its exploration and analysis of the issues involving psychiatry and psychiatric patients.
The development of internal forensic review boards in the management of hospitalized insanity acquittees R.F. Patterson, B.F. Wise Journal of the American Academy of Psychiatry & the Law 1998; 26(4): 661-664 When working well, internal forensic review boards generally: (1) have the support of the courts and communities; (2) consider and review effective individual treatment and public safety; (3) permit direct care treatment teams the opportunity to advocate for the patient; (4) focus clinical and security considerations on the individual patient rather than dwelling on system issues; (5) identify resource needs for inpatient and community care; (6) provide a foundation for monitoring patient adjustment to various levels of stressors, both in the hospital and the community; (7) provide a mechanism for timely crisis intervention for individual patients; (8) afford administrative and clinical staff a mechanism for peer review; (9) are cost effective compared with external review boards; (10) provide data and a tracking mechanism for quality improvement for the forensic system of care; and (11) provide an education/training function for direct care and professional staff.
Police attitudes toward mental illness and psychiatric patients in Israel R. Kimhi, Y. Barak, J. Gutman, Y. Melamed, M. Zohar, I. Barak Journal of the American Academy of Psychiatry & the Law 1998; 26(4): 625-630 The attitude of the public toward mental illness and toward psychiatric patients raises a serious and sensitive issue that indirectly affects the development of community mental health services. Most citizens feel that there is an association between mental illness and dangerous or violent behavior. Studies undertaken among police personnel in the 1970s demonstrated that their attitudes were similar to those of the general public in Israel. The objective of the present study was to assess the attitudes of police officers toward mental illness and psychiatric patients by means of a selfreport questionnaire. Ninety-three policemen from five police stations within the Y. Abarbanel Mental Health Center catchment area participated in the study. All were young males (average age 32.1 years) and 75 percent had a high school education or higher.
More than half (54.5%) had personally known a psychiatric patient in the past, and 20.4 percent of the police personnel graded mental illness as the severest form of disease in medicine. A minority (14.3%) of policemen agreed with the statement: 'A psychiatric hospital should be fenced and manned by guards'. One-third did not know whether psychiatric patients are dangerous. We conclude that training of police officers is called for to effect changes in their misconceptions about psychiatric patients. Psychoeducation may lead to improved handling by the police of incidents involving the mentally ill.
Culture, law and psychiatry in Hawaii R. A. Schultz-Ross, L. Jenkins Psychiatry & Clinical Neuroscience 1998; 52(supl): $374-$376 Hawaii is a set of islands with a broad mix of cultures. The law is American, but it was predominantly derived from English Common Law. Thus, the law is derived from a very distant culture. Theoretically, this 'transplanted' law could cause difficulties for people from Pacific cultures. Indeed, it appears to create difficulties for individuals with mental illness. A substantial number of these people are arrested for disobedience of a law that is not sensible for their culture. This problem is an example of the need for cultural knowledge when a psychiatrist conducts an examination for the legal system. An individual may appear legally guilty or medically insane when acting within cultural norms.
TIME OF DEATH Strontium90 for determination of time since death P. Neis, R. Hille, M. Paschke, G. Pilwat, A. Schnabel, C. Niess, H. Bratzke Forensic Science International 1999; 99(1): 47-51 Strontium90 (Sr90) is an artificial nuclear fission product of the atmospheric a-bomb testing between 1945 and 1979. It was spread throughout the atmosphere in the following years. Sr90 is an analogue to calcium and, therefore, enriched in human bones. Several studies especially in the 1960s and 1970s were undertaken to investigate the Sr90 burden and the resulting incorporated radiation in humans, but present studies are missing. In this study nine bone samples, three from 1931/32 and six from 1989 to 1994 were examined by measuring the Sr90 radiation. The samples from 1931/32 did not show any Sr90 activity. All the samples from 1989 and later showed a Sr90
Literature citation activity, but the intensity was very variable. Subsequent investigations should be done to determine the cut-off year for measurable Sr90 activity. Furthermore, the determination of a specific time since death depending on Sr90 activity should be possible, due to the ranging Sr90 pollution between 1950 and 1980 and different uptake in adolescents and adults.
SUBSTANCE MISUSE
Comparative profiles of addicted adult populations in rehabilitation and correctional services S. Brochu, L. Guyon, L. Desjardins Journal of Substance Abuse Treatment 1999; 16(2): 173-182 For many years, clinicians, especially those working in rehabilitation centers for alcohol and drug users, have been preoccupied with clients presenting with dual diagnosis: substance abuse and legal problems. Comparative analyses of three groups of addicted men, 553 offenders and 499 non-offenders in treatment for addiction problems and 103 addicted inmates were made to ascertain the biopsychosocial profile of these persons. Results showed that dualdiagnosis clients experienced more severe biopsychosocial problems than the nonoffending group of subjects. Offenders in prison experienced more social maladjustment than offenders in drug addiction treatment, they were less preoccupied by their drug consumption, and less motivated to change. Implications for treatment are discussed.
Suicide methods and presence of intoxicating abusable substances: some clinical and public health implications C.L. Rich, D.M. Dhossche, S. Ghani, G. Isacsson Annals of Clinical Psychiatry 1998; 10(4): 169-175 Toxicological studies have reported the presence of alcohol in about a third of suicides. Some have suggested that the presence of alcohol might predispose suicidal people to use particular methods, e.g. guns, although, in general, this does not appear to be the case. More recently, comprehensive toxicological studies have provided data on the detection of all intoxicating abusable substances (IAS) among suicides. The purpose of this report is to examine the presence of two samples of suicides to see if any relationships between presence of IAS at post mortem toxicology and any specific suicide method. The samples included 179 suicides from San Diego,
263
California (1981-1982), and 225 suicides from Mobile, Alabama (1990-1995) for which comprehensive toxicological examination had been conducted. Methods were grouped into more immediately fatal (MIF) and less immediately fatal (L1F) categories. The most common method in each category (guns and overdoses respectively) as examined separately as well. The same proportions of men (51%) and women (65%) were positive for any IAS in both locations. There were no significant differences in the proportions of suicides that were positive for IAS between the sample totals or by gender or age groups (under age 30 and age 30 and over) for any of the methods or categories examined. Significantly more of the Mobile suicides were by MIF methods than in San Diego for both genders, almost totally attributable to the use of guns. The use of guns for suicide in Mobile (and the state of Alabama) was also significantly higher than the rest of the USA in the early 1990s. Nonetheless, the suicide rates for men and women in Mobile (and Alabama) were no higher than for the overall USA rates. We conclude that potentially suicidal people should be advised to avoid intoxicating abusable substances of any kind. We also suggest that physicians should avoid prescribing such substances to depressed or suicidal patients.
Heroin fatality due to penile injection C.L. Winek, W.W. Wahba, L. Rozin American Journal of Forensic Medicine & Pathology 1999; 20 (1):90-92 Death due to heroin overdose and/or rapid injection of heroin is a frequent occurrence among opioid addicts. We present an unusual case of heroin fatality due to the injection of the drug in the penis. Blood, urine, bile, and vitreous humor concentrations of morphine were 0.68, 0.49, 0.32 and 0.062 microg/ml, respectively. Ethanol was detected at concentrations of 104, 124, 106, and 94 mg/dl in the blood, urine, bile, and vitreous humor, respectively. The cause of death was determined to be due to heroin and ethanol intoxication.
The management of opiate addicts in police custody S.E. Davison, M. Gossop Medicine, Science & the Law 1999; 39 (2): 153 160 Many suspects detained at police stations for questioning are under the influence of illicit drugs. This presents a problem, as the reliability of confessions made under the influence of drugs or whilst experiencing withdrawal symptoms may be adversely affected. This paper reviews the current management of opiate addicts in police custody and relevant legis-
Journal of Clinical Forensic Medicine
psychiatrists may fully participate in the debate and aid the court in its exploration and analysis of the issues involving psychiatry and psychiatric patients.
The development of internal forensic review boards in the management of hospitalized insanity acquittees R.F. Patterson, B.F. Wise Journal of the American Academy of Psychiatry & the Law 1998; 26(4): 661-664 When working well, internal forensic review boards generally: (1) have the support of the courts and communities; (2) consider and review effective individual treatment and public safety; (3) permit direct care treatment teams the opportunity to advocate for the patient; (4) focus clinical and security considerations on the individual patient rather than dwelling on system issues; (5) identify resource needs for inpatient and community care; (6) provide a foundation for monitoring patient adjustment to various levels of stressors, both in the hospital and the community; (7) provide a mechanism for timely crisis intervention for individual patients; (8) afford administrative and clinical staff a mechanism for peer review; (9) are cost effective compared with external review boards; (10) provide data and a tracking mechanism for quality improvement for the forensic system of care; and (11) provide an education/training function for direct care and professional staff.
Police attitudes toward mental illness and psychiatric patients in Israel R. Kimhi, Y. Barak, J. Gutman, Y. Melamed, M. Zohar, I. Barak Journal of the American Academy of Psychiatry & the Law 1998; 26(4): 625-630 The attitude of the public toward mental illness and toward psychiatric patients raises a serious and sensitive issue that indirectly affects the development of community mental health services. Most citizens feel that there is an association between mental illness and dangerous or violent behavior. Studies undertaken among police personnel in the 1970s demonstrated that their attitudes were similar to those of the general public in Israel. The objective of the present study was to assess the attitudes of police officers toward mental illness and psychiatric patients by means of a selfreport questionnaire. Ninety-three policemen from five police stations within the Y. Abarbanel Mental Health Center catchment area participated in the study. All were young males (average age 32.1 years) and 75 percent had a high school education or higher.
More than half (54.5%) had personally known a psychiatric patient in the past, and 20.4 percent of the police personnel graded mental illness as the severest form of disease in medicine. A minority (14.3%) of policemen agreed with the statement: 'A psychiatric hospital should be fenced and manned by guards'. One-third did not know whether psychiatric patients are dangerous. We conclude that training of police officers is called for to effect changes in their misconceptions about psychiatric patients. Psychoeducation may lead to improved handling by the police of incidents involving the mentally ill.
Culture, law and psychiatry in Hawaii R. A. Schultz-Ross, L. Jenkins Psychiatry & Clinical Neuroscience 1998; 52(supl): $374-$376 Hawaii is a set of islands with a broad mix of cultures. The law is American, but it was predominantly derived from English Common Law. Thus, the law is derived from a very distant culture. Theoretically, this 'transplanted' law could cause difficulties for people from Pacific cultures. Indeed, it appears to create difficulties for individuals with mental illness. A substantial number of these people are arrested for disobedience of a law that is not sensible for their culture. This problem is an example of the need for cultural knowledge when a psychiatrist conducts an examination for the legal system. An individual may appear legally guilty or medically insane when acting within cultural norms.
TIME OF DEATH Strontium90 for determination of time since death P. Neis, R. Hille, M. Paschke, G. Pilwat, A. Schnabel, C. Niess, H. Bratzke Forensic Science International 1999; 99(1): 47-51 Strontium90 (Sr90) is an artificial nuclear fission product of the atmospheric a-bomb testing between 1945 and 1979. It was spread throughout the atmosphere in the following years. Sr90 is an analogue to calcium and, therefore, enriched in human bones. Several studies especially in the 1960s and 1970s were undertaken to investigate the Sr90 burden and the resulting incorporated radiation in humans, but present studies are missing. In this study nine bone samples, three from 1931/32 and six from 1989 to 1994 were examined by measuring the Sr90 radiation. The samples from 1931/32 did not show any Sr90 activity. All the samples from 1989 and later showed a Sr90
Literature citation activity, but the intensity was very variable. Subsequent investigations should be done to determine the cut-off year for measurable Sr90 activity. Furthermore, the determination of a specific time since death depending on Sr90 activity should be possible, due to the ranging Sr90 pollution between 1950 and 1980 and different uptake in adolescents and adults.
SUBSTANCE MISUSE
Comparative profiles of addicted adult populations in rehabilitation and correctional services S. Brochu, L. Guyon, L. Desjardins Journal of Substance Abuse Treatment 1999; 16(2): 173-182 For many years, clinicians, especially those working in rehabilitation centers for alcohol and drug users, have been preoccupied with clients presenting with dual diagnosis: substance abuse and legal problems. Comparative analyses of three groups of addicted men, 553 offenders and 499 non-offenders in treatment for addiction problems and 103 addicted inmates were made to ascertain the biopsychosocial profile of these persons. Results showed that dualdiagnosis clients experienced more severe biopsychosocial problems than the nonoffending group of subjects. Offenders in prison experienced more social maladjustment than offenders in drug addiction treatment, they were less preoccupied by their drug consumption, and less motivated to change. Implications for treatment are discussed.
Suicide methods and presence of intoxicating abusable substances: some clinical and public health implications C.L. Rich, D.M. Dhossche, S. Ghani, G. Isacsson Annals of Clinical Psychiatry 1998; 10(4): 169-175 Toxicological studies have reported the presence of alcohol in about a third of suicides. Some have suggested that the presence of alcohol might predispose suicidal people to use particular methods, e.g. guns, although, in general, this does not appear to be the case. More recently, comprehensive toxicological studies have provided data on the detection of all intoxicating abusable substances (IAS) among suicides. The purpose of this report is to examine the presence of two samples of suicides to see if any relationships between presence of IAS at post mortem toxicology and any specific suicide method. The samples included 179 suicides from San Diego,
263
California (1981-1982), and 225 suicides from Mobile, Alabama (1990-1995) for which comprehensive toxicological examination had been conducted. Methods were grouped into more immediately fatal (MIF) and less immediately fatal (L1F) categories. The most common method in each category (guns and overdoses respectively) as examined separately as well. The same proportions of men (51%) and women (65%) were positive for any IAS in both locations. There were no significant differences in the proportions of suicides that were positive for IAS between the sample totals or by gender or age groups (under age 30 and age 30 and over) for any of the methods or categories examined. Significantly more of the Mobile suicides were by MIF methods than in San Diego for both genders, almost totally attributable to the use of guns. The use of guns for suicide in Mobile (and the state of Alabama) was also significantly higher than the rest of the USA in the early 1990s. Nonetheless, the suicide rates for men and women in Mobile (and Alabama) were no higher than for the overall USA rates. We conclude that potentially suicidal people should be advised to avoid intoxicating abusable substances of any kind. We also suggest that physicians should avoid prescribing such substances to depressed or suicidal patients.
Heroin fatality due to penile injection C.L. Winek, W.W. Wahba, L. Rozin American Journal of Forensic Medicine & Pathology 1999; 20 (1):90-92 Death due to heroin overdose and/or rapid injection of heroin is a frequent occurrence among opioid addicts. We present an unusual case of heroin fatality due to the injection of the drug in the penis. Blood, urine, bile, and vitreous humor concentrations of morphine were 0.68, 0.49, 0.32 and 0.062 microg/ml, respectively. Ethanol was detected at concentrations of 104, 124, 106, and 94 mg/dl in the blood, urine, bile, and vitreous humor, respectively. The cause of death was determined to be due to heroin and ethanol intoxication.
The management of opiate addicts in police custody S.E. Davison, M. Gossop Medicine, Science & the Law 1999; 39 (2): 153 160 Many suspects detained at police stations for questioning are under the influence of illicit drugs. This presents a problem, as the reliability of confessions made under the influence of drugs or whilst experiencing withdrawal symptoms may be adversely affected. This paper reviews the current management of opiate addicts in police custody and relevant legis-