The role of the psychiatrist in the practice of psychotherapy

Historically, psychiatry has played a dominant role in psychotherapeutics, but recently, other mental-health professionals are challenging the role. This paper discusses psychiatrists' different conceptualization of problems and underlines the special contributions they are qualified to make because of their medical training. Patients should be free to choose the type of treatment approach--psychiatric or nonpsychiatric--that best serves their needs.     

The role of the psychiatrist in dangerous offender hearings

The current Canadian legislation regarding dangerous offenders is reviewed, with specific emphasis on the role of the required psychiatric testimony. It is suggested that, although this legislation as it is currently formulated could be viewed as an attempt to broaden the insanity defence, and permit the diversion of mentally ill offenders from a punitive to a therapeutic milieu, it enables the preventive detention of recidivist offenders. Some fundamental ethical issues which follow from this are identified, together with the issues which have dominated expert testimony in hearings held in British Columbia during the past 13 years.     

The role of the child psychiatrist in peer review

The author describes his role as the only child psychiatrist member of a psychiatric peer review committee in a medical care foundation. In addition to working with hist colleagues on general review and health-policy matters, he also handled issues related to the special needs of children and helped to get third-party benefit packages altered to better suit the treatment needs of children. He offers recommendations to those interested in joining a peer review committee and emphasizes the need for child psychiatrists to work together not only with general psychiatrists but also with pediatricians, psychologists, and social workers to see that high-quality care is available and provided.     

The role of the psychiatrist in the criminal justice system

In this article, the author explores the relationship between the lawyer as advocate and the psychiatrist as expert. He argues that the role of the psychiatrist in aiding the Court in the determination of relevant issues is one of increasing importance. Often the diagnostic opinions offered by the psychiatrist border on conclusory legal determination. As such, those opinions must necessarily be subjected to the testing of adversarial processes. The role of the psychiatrist is to proffer a relevant opinion while nevertheless realizing that the inexact nature of the science limits the use such an opinion may have. The lawyer as adversary must subject that opinion to as rigorous an examination as possible. This examination is not an affront to the psychiatrist but rather an attempt to explore and expose the definitiveness of that opinion. It is through this combination of realized opinionating and adversarial examination that relevant legal-medical determinations can best be made within the confines of our existing judicial mode of dispute settlement.     

环孢素A在器官移植中的免疫抑制作用☆

学术背景：研究表明环孢素A具有强免疫抑制作用，目前已被广泛应用于临床器官移植领域。 目的：综合分析近年来环孢素A的免疫抑制作用及其途径。 检索策略：应用计算机检索，以北京大学医学图书馆网络数据库资源为主，查询 ScienceDirect Onsite，ProQuest，Springer, Ovid 等数据库 1990-01/2006-12有关环孢素A免疫抑制机制方面的文章，检索词为“cyclosporine A，mechanism/action，immunosuppression”，并限定文章语言种类为English。初检得到68篇文献，阅读标题和摘要进行初筛。纳入标准：文章所述重点与环孢素A的免疫抑制机制相关。排除标准：重复研究。共50篇文章符合纳入标准，取其中有关气管移植的46篇文献进一步查找全文归纳总结。 文献评价：46篇文献中6篇涉及环孢素A已知的临床应用和效果，40篇涉及环孢素A的分子生物学机制。 资料综合：通过文献回顾，发现环孢素A免疫抑制机制集中于以下方面：①钙神经蛋白/活化的T细胞核因子途径方面的作用。②对JNK与P38信号通路的作用。③其他作用。 结论：环孢素A一方面选择性地调节淋巴细胞亚群的功能；另一方面抑制T毒性细胞的活化，还可能抑制T记忆细胞的形成或反应。但它不影响T抑制细胞亚群的活化与增殖，对T抑制细胞表达白细胞介素2受体无影响，从而导致了选择性的免疫抑制。     

The treating psychiatrist thrust into the role of expert witness

Treating psychiatrists may precipitously and unwittingly be thrust into the role of expert witness because of certain actions they may take on behalf of their patients and may suffer adverse consequences as a result of lack of training and experience. The authors review this problem and suggest means of avoiding the pitfalls involved. Recommendations include warning patients of the uses that will be made of communications between their treaters and third parties, recording the sources of clinical data for use in communications with the legal system, separating the roles of treating psychiatrist and expert witness, and consulting with attorneys or experienced forensic practitioners.     

The forensic role of the child psychiatrist in child abuse and neglect cases

Child psychiatrists play important roles in the legal system. By training and experience, they have unique insight into the emotional life of the child, the dynamics of the family system, and the relationship between child and parent. They help provide objective information to the judge and jury for making difficult legal decisions in child abuse and neglect-related cases. Functioning in various roles, child psychiatrists must reach a clear understanding with the hiring party as to the reason for the consultation, what materials and interviews are necessary for a comprehensive evaluation, the charges involved, and ethical principles to be followed. They must recognize and negotiate the challenges for objectivity in these forensic evaluations. Finally, they should understand that the role of the child psychiatrist in forensic issues is a dynamic one that is shaped by the ever-evolving response of society, law, and the medical profession to the phenomena of child abuse and neglect.