The nature of neonatal status epilepticus — a clinician's perspective

Neonatal status epilepticus occurs within the substrate of the hyperexcitable newborn brain and is usually provoked by acute CNS derangements, although status can also be the presentation of early-life epilepsy. Provoked neonatal status usually resolves within a few days, with or without treatment, but new data suggests that status is associated with adverse outcomes, even after controlling for underlying disease severity and MRI structural brain injury. Novel treatments may be needed to improve seizure control and outcome, given the characteristics of neurotransmission in the newborn brain.This article is part of a Special Issue entitled “Status Epilepticus”.     

Automatisms: bridging clinical neurology with criminal law

The law, like neurology, grapples with the relationship between disease states and behavior. Sometimes, the two disciplines share the same terminology, such as automatism. In law, the "automatism defense" is a claim that action was involuntary or performed while unconscious. Someone charged with a serious crime can acknowledge committing the act and yet may go free if, relying on the expert testimony of clinicians, the court determines that the act of crime was committed in a state of automatism. In this review, we explore the relationship between the use of automatism in the legal and clinical literature. We close by addressing several issues raised by the automatism defense: semantic ambiguity surrounding the term automatism, the presence or absence of consciousness during automatisms, and the methodological obstacles that have hindered the study of cognition during automatisms.     

Impact of molecular medicine on neuropsychiatry: the clinician's perspective

Clinical neuropsychiatry has traditionally relied on individual practitioner experience or the apprentice-training model for formulating cases and choosing treatment. Scientifically-based diagnostic criteria and treatment algorithms have been lacking in the overlap area between psychiatry and neurology, owing largely to the complexity of this population population. However, the novel application of new molecular technologies is promising to change the care of neuropsychiatric patients. This review will highlight recent advances in molecular medicine pertaining to neuropsychiatry.Introduction     

The management of subependymal giant cell tumors in tuberous sclerosis: a clinician's perspective

Background  

Tuberous sclerosis (TSC) is a genetic multisystem disorder associated with hamartomas in several organs including subependymal giant cell tumors (SGCT). SGCT have the potential to grow and therefore to become symptomatic and are one of the main causes of death in TSC individuals. Surgical resection is the procedure of choice for SGCT. However, the discovery of mTOR pathway upregulation in TSC-associated tumors and recent evidence that mTOR inhibitors may induce regression of SGCT open up new treatment strategies. Based on a review of the currently available literature and on personal experience, current options for the management of TSC patients and appropriate indications, taking into account benefits and risks of surgery and pharmacotherapy, are discussed.     

Cultural considerations in the criminal law: the sentencing process

In forensic psychiatry, there is increasing recognition of the importance of culture and ethnicity in the criminal justice process as the population becomes more culturally diverse. However, there has been little consideration of the role of cultural factors in the trial process for criminal defendants, particularly in the sentencing phase of trial. Using a capital murder case study, this article explores the role of cultural forensic psychiatric consultation, focusing on the sentencing phase of trial as the place where the full scope and power of a cultural evaluation can be brought most effectively to the attention of the court. Cultural psychiatric perspectives can enrich a core forensic evaluation and be maximally helpful to the court, by exploring family dynamics and psychological health influenced by cultural history, immigrant and refugee experiences, and sociocultural environment. Specific recommendations and cautions for effective cultural consultation in forensic psychiatry are discussed.     

Recognition of intellectual disability in the criminal justice system: The role of law

Much fine work has recently emerged on the recognition of intellectual disability in the criminal justice system including particularly the report of the New South Wales Law Reform Commission on Policing Issues as part of the reference to it in respect of “People with an Intellectual Disability and the Criminal Justice System.¹ In that context this article does not seek to canvass ground which has been covered in such sources with greater particularity. Rather, this article examines the manner in which the law does or can achieve recognition of intellectual disability in the criminal justice system. In what ways has “the law” been seen to act or in what ways is it proposed it should act? Does the law bring “order” to the recognition of intellectual disability within the criminal justice system?     

Providing mental health services to adult offenders in Victoria,Australia: Overcoming barriers

PurposeTo illustrate the development of the interface between general and forensic mental health services in Victoria, Australia.MethodDeveloping effective cooperation between the general and forensic mental health services requires overcoming a number of barriers. The attitude of general services that antisocial behaviour was none of their business was tackled through ongoing workshops and education days over several years. The resistance to providing care to those disabled by severe personality disorders or substance abuse was reduced by presenting and promoting models of care developed in forensic community and inpatient services which prioritised these areas. The reluctance of general services to accept offenders was reduced by involving general services in court liaison clinics and in prisoner release plans. Cooperation was enhanced by the provision of risk assessments, the sharing of responsibility for troublesome patients, and a problem behaviours clinic to support general services in coping with stalkers, sex offenders and threateners.ConclusionsActive engagement with general services was promoted at the level of providing education, specialised assessments and a referral source for difficult patients. This generated a positive interface between forensic and general mental health services, which improved the quality of care delivered to mentally abnormal offenders.     

Integrated services for chronic mental patients: Theoretical perspective and experimental results

The theoretical basis of an integrated service approach to the care of chronic mental patients is discussed. An experiment testing the Treatment Network Team (TNT) program, based on that approach, is described and results are reported. Although TNT and control patients exhibited minimal differences in symptomatology and psychopathology, those in the experimental group showed substantive improvement in psychosocial functioning. The authors conclude that flexible service systems that deemphasize locus of care and offer a range of treatment modalities have the potential for enriching the social lives of chronic mental patients.