The child as a witness

The increasing participation of children in judicial proceedings raises two central issues: the competency of the child as a witness and the effects on the child of testifying about a traumatic experience. After discussing these issues, the authors present the recommendations of forensic child psychiatrists on how to improve the judicial process to elicit more accurate testimony from child witnesses--for example, by videotaping a child's testimony to avoid repeated interrogations, using anatomically correct dolls and pictures to allow the child to recount events through displacement, and using one skilled interviewer throughout the proceeding to allow rapport to develop between interviewer and child. They then discuss the role of the child psychiatrist in court proceedings involving child witnesses.     

Cerebral granular cell tumors: report of a case and a note on their nature and expected behavior

Summary A case of cerebral granular cell tumor (GCT) is reported. Histologically, the growth was composed of benign astrocytes, granular cells and transitional forms between both elements. Glial fibrillary acidic protein was detected in the glial component and, to a lesser extent, in the granular cells. Alpha-1-antichymotrypsin was demonstrated in the latter component only. Ultrastructural study also supported the evidence that neoplastic astrocytes became granular cells. The survey of the literature and our own results suggest that GCTs in this particular location, even when histologically benign, seem to have a worse prognosis than the low-grade supratentorial astrocytomas.     

From mental health professional to expert witness: testifying in court

Our democratic principles rest on the belief that truth is discovered through the fair and open combat of ideas in a court of law. When mental health professionals participate in this adversary process as expert witnesses, it is essential for them to understand that attorneys will attempt to impeach their credibility. Mental health professionals who appreciate the spirit and mechanics of courtroom communication will be best prepared to protect the integrity of their testimony. The courtroom communications model provides experts with a conceptual framework utilizing three components: the speaker is the expert, the message is testimony, and the audience is the judge or jury. Within the structure of this model, communication principles from social psychology can be used to enhance the clarity of testimony and to prevent attorneys from distorting the expert's opinions. First and foremost, expert witness testimony must be formulated on accepted scholarly and ethical standards. To establish credibility, experts must appear knowledgeable and trustworthy to the judge and jury. The expert must come to court prepared for both direct examination and cross-examination, know when to emphasize logic or emotion, tailor speech in order to reach the maximum number of jurors, and remain nondefensive by projecting the same demeanor regardless of which side is conducting the examination. The role of the expert witness is forever changing because the judicial system--like the mental health field--continues to evolve. Although the adversary process has undergone dramatic changes over the past eight hundred years, historical vestiges continue to echo throughout our courtrooms. Today expert witnesses are the champions of both victims and the accused. Legal disputes are increasingly being decided by the battle of the experts, who must undergo the ordeal of cross-examination. When you consider the brutality of ancient ordeals, responding to attorneys armed with questions may not seem so daunting.     

Psychoanalysis applied to medicine: a personal note.

The psychoanalyst has much to contribute to medicine, more through the teaching of observational skills and an appreciation of relationships than through the teaching of psychoanalytic technique or languate itself. The analyst can promote tolerance in the physician of the unusual, an examination of the impediments of habitual ways of working and seeing, and a facility in the patient to "be himself". Attention to the unusual, as illustrated through experience in training-cum-research seminars, can enhance the doctor's satisfaction with his professional life while offering improved care to his patients. When psychoanalyst, physician and patient interact in their roles as people, there is hope of an improved quality of human existence for all.     

Expert witness testimony: An update

This update provides an overview of the current state of expert witness testimony regarding malpractice cases. Many trials are reduced to a battle of the experts and many physicians advertise their credentials and expertise in hopes of attracting lucrative cases. This article focuses on what constitutes an expert witness, medical organizations oversight, the peer review process, and physician immunity.     

Ictal Grasping: Prevalence and Characteristics in Seizures with Different Semiology

Summary:  Purpose: The aim of this study was to investigate ictal grasping (IG), defined as the act of gripping something firmly during focal epileptic seizures, and to evaluate whether it characterizes specific seizure types.
Methods: We analyzed the video-recordings of 694 seizures in 109 consecutive candidates to epilepsy surgery. Seizures with motor manifestations (n = 511) were selected and divided into four semiological groups: (a) frontal "hyperkinetic" seizures (FHS): 30 seizures, 12 patients, (b) frontal lobe seizures (FLS) other than FHS: 228 seizures, 26 patients, (c) temporal lobe seizures (TLS): 194 seizures, 55 patients, (d) extra-frontal/extra-temporal seizures (EF/ETS): 59 seizures, 16 patients. We evaluated IG features by means of video-analysis.
Results: IG was observed in 96.7% of FHS (100% of patients), with a mean latency of 3 s, and a mean prevalence of 7.9 IG per seizure, directed to a limited number of surrounding objects or body parts. In 22.4% of FLS (11.5% of patients) 1–3 prolonged IGs were present, with a mean latency of 2 s and mainly directed to a fixed external point. IG was occasionally present in TLS (10.3%, in 20% of patients) and EF/ETS (5.1%, in 12.5% of patients), with longer latencies and without any stereotypy. We did not find a reliable lateralizing value of IG.
Conclusions: Prevalence of IG in FHS was significantly higher than in other seizure groups. In FHS and FLS, IG had shorter latency and stereotyped features, characterizing an automatic ("release"?) behavior. In extra-frontal seizures, IG seemed to be an occasional purposeful movement.     

Introduction to a mythical family: how to do experiential psychotherapy

Experiential psychotherapy is generally accepted as one of the major families of psychotherapy. One of the main purposes of this introduction to the theme issue is to invite leading proponents and exponents to provide their own answers to the question of how to do experiential psychotherapy, with the emphasis on what would be helpful to students, trainees, and practitioners somewhat familiar with the approach. A second main purpose is to make a case that the very idea of an "experiential family" is a myth. There is no such thing as an "experiential family" of psychotherapies. There are not distinctively common family characteristics.     

Brief report: how anxiously withdrawn preadolescents think about friendship

Previous research suggests that anxiously withdrawn preadolescents demonstrate success in forming friendships, yet these friendships tend to be of lesser quality. Drawing on Selman's (1980) theory of interpersonal understanding, we compared levels of friendship understanding between anxiously withdrawn preadolescents and a sample of non-withdrawn age mates. Fifth graders (N = 116; 58% girls; mean age = 10.33 yrs) completed same-sex friendship and social behavior nominations, as well as a semi-structured clinical interview assessing understanding of various friendship issues in response to a hypothetical friendship dilemma. Results suggest that anxiously withdrawn preadolescents demonstrated lower levels of friendship understanding for some, but not all, friendship issues that may be related to friendship quality. The findings suggest that social cognitive assessments of friendship may be useful in understanding the friendship successes and difficulties of anxiously withdrawn preadolescents.     

Removal of multiple intracranial meningiomas preceded by intravascular embolization in a Jehovah's witness patient. Case report

The paper presents a case of a Jehovah's Witness, 64-year-old woman harboring multiple meningiomas in the right cerebral hemisphere. As the first stage of her treatment endovascular embolization of the tumor vascular bed was performed. Through the middle cerebral artery Ivalon particles and acrylic glue were injected. Four days later the patient underwent craniotomy and four intracranial meningiomas were removed. Intraoperative blood loss was minimal and the patient was discharged with no neurological sequelae and without anemia. The authors emphasize benefits that endovascular embolization may bring, especially as regards improvement of neurosurgical treatment safety in Jehovah's Witnesses.