Against the Odds: Psychomotor Development of Children Under 2 years in a Sudanese Orphanage.

Providing abandoned children the necessary medical and psychological care as possible after their institutionalization may minimize developmental delays. We describe psychomotor development in infants admitted to an orphanage in Khartoum, Sudan, assessed at admission and over an 18-month follow-up. Psychological state and psychomotor quotients were determined using a simplified Neonatal Behavior Assessment Scale (NBAS), the Brunet-Lezine and Alarm distress baby (ADBB) scale. From May-September 2005, 151 children were evaluated 2, 4, 9, 12 and 18 months after inclusion. At admission, ∼15% of children ≤1 month had a regulation impairment according to the NBAS, and 33.8% presented a distress state (ADBB score >5). More than 85% (129/151) recovered normal psychomotor development. The results of the program reinforce the importance of early detection of psychological disorders followed by rapid implementation of psychological case management to improve the development of young children in similar institutions and circumstances

Exploring the similarities and differences between medical assessments of competence and criminal responsibility

The medical assessments of criminal responsibility and competence to consent to treatment are performed, developed and debated in distinct domains. In this paper I try to connect these domains by exploring the similarities and differences between both assessments. In my view, in both assessments a decision-making process is evaluated in relation to the possible influence of a mental disorder on this process. I will argue that, in spite of the relevance of the differences, both practices could benefit from the recognition of this similarity. For cooperative research could be developed directed at elucidating exactly how various mental disturbances can affect decision-making processes

Free will and psychiatric assessment of criminal responsibility. A parallel with informed consent

In some criminal cases a forensic psychiatrist is asked to make an assessment of the state of mind of the defendant at the time of the legally relevant act. A considerable number of people seem to hold that the basis for this assessment is that free will is required for legal responsibility, and that mental disorders can compromise free will. In fact, because of the alleged relationship between the forensic assessment and free will, researchers in forensic psychiatry also consider the complicated metaphysical discussions on free will relevant to the assessment. At the same time, there is concern about the lack of advancement with respect to clarifying the nature of the forensic assessment. In this paper I argue that, even if free will is considered relevant, there may be no need for forensic researchers to engage into metaphysical discussions on free will in order to make significant progress. I will do so, drawing a parallel between the assessment of criminal responsibility on the one hand, and the medical practice of obtaining informed consent on the other. I argue that also with respect to informed consent, free will is considered relevant, or even crucial. This is the parallel. Yet, researchers on informed consent have not entered into metaphysical debates on free will. Meanwhile, research on informed consent has made significant progress. Based on the parallel with respect to free will, and the differences with respect to research, I conclude that researchers on forensic assessment may not have to engage into metaphysical discussions on free will in order to advance our understanding of this psychiatric practice. © 2010 The Author(s)

Beside-the-mind: an unsettling, reparative reading of paranoia

Having undertaken a critical analysis of a transnational program of research to identify and intervene on the prodrome, a pre-psychotic state, here I experiment with an unsettling, reparative reading of its affective coils—paranoia. Etymologically joining para (beside) with nous (mind), “paranoia” denotes an experience beside-the-mind. I attempt to follow these roots, meeting a non-human figure—Coatlicue—as introduced through Chicana philosopher and poet, Gloria Anzaldúa. In the arms of this goddess, the prodrome points to the vitality and the milieu of paranoia, re-turning it as a capacity, calling for modes of attunement and apprenticeship, and perhaps protecting our psychological and political practices against yet another operation of colonialist capture. Challenging the subject, interlocutors, and form typically adopted by not just Psychology but Affect Studies too, I hope in this performative essay to also lift up the problems and possibilities of Walter Mignolo’s ‘border thinking’ as a means to open the potential decoloniality, and thus response-ability, of these fields within the present political moment

Ethics in correctional mental health

Working as a psychiatrist in a jail or prison presents many ethical issues, many unique to the correctional setting. Obligations to the law, professional standards, the community, and public health require a complex appreciation of competing values. It remains an extraordinary commentary on the state of mental health that the largest mental health institutions in the United States are jails and prisons. In daily practice, acknowledging healthcare, individual, and professional values in a robust vision of professionalism means advocating for clinical values and opposing mistreatment. Making the limits of confidentiality clear is a time-honored element of the informed consent process and need not be diluted in the correctional system. Honoring clear boundaries between treatment and forensic evaluation are the crux of this issue: confidentiality warnings and access to counsel cannot be one-off affairs that do not account for the cognitive, educational, or mental health vulnerabilities of the patient in a correctional setting. Developing trust, offering transparency, and delivering clear descriptions of procedural requirements are the lessons of an empirical database that supports this approach and can lead to more collaboration and less violence. This chapter presents a discussion of the critical concerns, including informed consent and coercion, dual agency, appropriate access to care, and managing professional boundaries and standards.</p

Factors influencing adjudicative competence and length of time to restoration

Few studies on adjudicative competence explore the relationship between diagnosis, treatment, and restorability. Most focus on demographics and major psychiatric diagnosis with very few exploring the diagnoses common to the forensic population (i.e., personality disorders and substance abuse). Our study of 365 defendants who were incompetent to stand trial at a state psychiatric facility indicates that non-restored defendants have a greater likelihood of cognitive disorders, misdemeanor charges, and histories of prior hospitalization, and less likelihood of personality disorders. In addition, the odds of having a substance use disorder and being medication non-adherent was greater among restored defendants. The mean length of time to restoration (LOR) of 56 days was significantly different from the mean length of time to adjudication (LOA) for those not restored (88 days). This study supports prior literature on restorability while distinguishing those treated for psychosis from those treated for substance use and personality disorder. In its novel focus on medication adherence, the study expands the remediable factors available to clinical and forensic professionals and supports interventions that improve treatment and shorten the time to restoration