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Biomedical subjects

Douglas Mossman

Publications and source records attributed to Douglas Mossman.

7 recordsLinked to original sources
PubMed2006

Another look at interpreting risk categories.

Several studies over the past decade have shown that simple rating scales can accurately rank sex offenders' long-term risk of recidivism. But when using these scales as prediction tools, evaluators often wish to translate categories of risk into probabilities of recidivism. D. M. Doren (2004) has recently suggested that evaluators may use the recidivism percentages published in original studies of the RRASOR and STATIC-99 without regard to differences in populations or base rates. This article explains why Doren's computations should lead to a different conclusion, and describes how simply comparing percentages across studies can mislead researchers and clinicians. Instead, investigators should isolate and examine the detection properties of risk assessment instruments alone, independent of the population- or setting-specific base rate. This article explains this process, using an imaginary study to illustrate how base rates and the properties of risk assessment instruments yield estimated probabilities of recidivism. The article also shows why Doren's results imply that the percentages of recidivism associated with scores on the RRASOR and STATIC-99 scores may vary across study populations. The article offers recommendations for researchers who design and evaluate actuarial methods of assessing risk and for clinicians who interpret results from risk assessment instruments.

Actuarial Analysis↗
PubMed2003

Daubert, cognitive malingering, and test accuracy.

Daubert v. Merrell Dow Pharmaceuticals (1993) held that trial judges should permit expert scientific testimony only when "the reasoning or methodology underlying the testimony is scientifically valid, and ... properly can be applied to the facts in issue." Vallabhajosula and van Gorp ("V & vG," 2001) have suggested that when the Daubert standard is applied to tests for malingered cognitive deficits, courts should deem admissible only results that meet this mathematical standard: assuming a pretest probability of .3, a "positive" score on the malingering test should yield a posttest probability of at least .8. This paper shows that V & vG's criterion may lead to misunderstandings about the kind of information maligering measures provide. After reviewing cases that have discussed both the Daubert decision and malingered cognitive deficits, this paper uses data from the Test of Memory Malingering (T.N. Tombaugh, 1996) to provide a general characterization of the mathematical properties of malingering measures. The paper then describes how pretest knowledge about malingering is combined with knowledge about a test's performance to generate a posttest probability of malingering. The results can help mental health experts respond to Daubert-inspired challenges to conclusions based on malingering measures.

Bayes Theorem↗
PubMed2002

AAPL practice guideline for forensic psychiatric evaluation of defendants raising the insanity defense. American Academy of Psychiatry and the Law.

The insanity defense is a legal construct that excuses certain mentally ill defendants from legal responsibility for criminal behavior. This practice guideline has delineated the forensic psychiatric evaluation of defendants raising the insanity defense. The document describes acceptable forensic psychiatric practices. Where possible, standards of practice and ethical guidelines have been specified. And where appropriate, the practice guideline has emphasized the importance of analyzing the individual case, the jurisdictional case law and the state (or federal) statute. This practice guideline is limited by the evolving case law, statutory language and legal literature. The authors have emphasized the statutory language of current legal standards, as well as the state or federal courts' interpretation of those standards because the same statutory language has been interpreted differently in different jurisdictions. Similarly, this practice guideline has reviewed the state and federal trends that determine which diagnoses meet the criteria for mental disease or defect. These trends yield to jurisdictional court interpretations. Finally, the authors hope this practice guideline has begun the dialogue about formulating a forensic psychiatric opinion by surveying the various approaches used to analyze case data. The forensic psychiatrist's opinion in each case requires an understanding of the current jurisdictional legal standard and its application, as well as a thorough analysis of the individual case. The psychiatrist's analysis and opinion should be clearly stated in the forensic psychiatric report. It should be noted that the role of a psychiatric expert witness in the criminal justice system is predicated on the law's interest in individualizing the criteria of mitigation and exculpation. Forensic psychiatric analyses and formulations of opinions are, therefore, subject to change as the legal guidance changes.

Ethics, Medical↗
PubMedDate not supplied

Tests of a symptom checklist to screen for comorbid psychiatric disorders in alcoholism.

In the treatment of substance use disorders, it is advantageous to identify patients with comorbid (nonsubstance) psychiatric disorders because treating comorbid disorders improves outcome. Because accurate psychiatric diagnosis is time-consuming, there is a need for strategies to screen for these comorbid conditions. This study used receiver operating characteristic analysis to investigate a symptom checklist (revised Symptom Checklist 90 [SCL-90-R]) as a screening instrument for comorbid conditions diagnosed using the Structured Clinical Interview for DSM-IV in 171 primarily military personnel with alcohol use disorders. Several approaches to applying receiver operating characteristic analysis to this problem are demonstrated. Although these results require replication in other populations, the SCL-90-R performed well in predicting comorbid conditions, with an area under the curve of 0.88 for current and 0.85 for lifetime comorbid diagnoses. Self-report symptom checklists such as the SCL-90-R may be useful in screening substance rehabilitation patients for more detailed psychiatric assessment and may prove clinically useful in the assessment of alcoholic patients.

Adolescent↗