Forensic Psychiatry

Question 1

What are the four conditions that must be proven to sustain a claim of malpractice?

Answer 1

1. physician had a duty of care
2. physician breached his/her duty by practice that did not meet the standard of care (negligence)
3. the patient was harmed
4. the harm was directly caused by the negligence

Question 2

What are some situations that do not require informed consent?

Answer 2

lifesaving medical emergency
prevention of suicidal or homicidal behavior
minors receiving obstetric care, STD treatment or substance abuse treatment

Question 3

What are the criteria for a minor to be considered emancipated?

Answer 3

1. self-supporting
2. in the military
3. married
4. with children

Question 4

What is the difference between capacity and competence?

Answer 4

capacity is a clinical term that can be applied by a physician

competence is a legal term that can only be decided by a judge

Question 5

What are the four things that must be present in order for a patient to have decisional capacity?

Answer 5

1. understand the relevant information regarding treatment
2. appropriate the appropriate weight and impact of the decision
3. logically manipulate the info to make the decision
4. communicate a choice or preference

Question 6

How should a guardian or conservator make decisions for a patient - by what principle?

Answer 6

substituted judgment (what the patient would most likely have expressed were the patient competent)

Question 7

Why was the Tarasoff case so important for psychiatry?

Answer 7

as a result, a physician who is treating a patient who may physically harm another individual, the physician is obligated to warn the potential victims about the impending threat

Question 8

True or false: patients who voluntarily admit themselves to a psychiatric ward have the right to be discharged upon request

Answer 8

false

Question 9

True or false: patients who are involuntarily admitted lose the right to refuse treatment.

Answer 9

false - you can involuntarily admit someone, but you need a separate court order to involuntarily medicate someone

Question 10

What percentage of cases attempting a “not guilty by reason of insanity” plea are successful?

Answer 10

only 2.5%

Question 11

What are the three insanity defense standards?

Answer 11

M’Naghten - person doesn’t understand what he was doing or it’s wrongfulness (this is the most stringent)

American Law Institute Model Penal Code - person could not appreciate right from wrong OR could not control actions (the irresistible impulse test)

Durham - person’s criminal act resulted from mental illness (most lenient and rarely used)

Question 12

Which of the mental health disorders have the highest increased risk of violence?

Answer 12

substance abuse/dependence between 12-16x the normal risk

and bipolar, depression and schizophrenia at 5x

Question 13

What is the most important factor in assessing a patient’s risk of violence?

what are some other factors?

Answer 13

the patient’s history of violence

specific threat with a plan
history of impulsivity
psychiatric diagnosis
substance abuse