PubMed Health⌕ Search

Biomedical subjects

R Weinstock

Publications and source records attributed to R Weinstock.

At least 37 records · Page 2Linked to original sources
PubMed1996

California's diminished capacity defense: evolution and transformation.

Diminished capacity survives in California as a severely attenuated mens rea defense known as diminished actuality. Some other states have similar limited strict mens rea defenses. The lost advantages of California's former expanded concept of diminished capacity are reviewed. As opposed to the all-or-none insanity defense, mens rea defenses permit the trier of fact to find gradations of guilt but are generally inapplicable unless the elements of a crime are redefined to permit consideration of motivational aspects, as California had done. The change from diminished capacity to a diminished actuality defense was a return to the complex, somewhat artificial legal concept of intent and a resurrection of confusing and antiquated common law definitions. The change was made in response to an unpopular jury verdict and a political climate in which little interest existed or still exists for understanding the reasons behind the commission of any crime. Some of the later restrictions imposed by the California Supreme Court on allowing voluntary intoxication to reduce murder to voluntary manslaughter logically should not apply to mental illness. Knowledge of the complex mens rea issues and the various relevant current defenses is essential for any forensic psychiatrist evaluating defendants in jurisdictions in which such defenses are admissible.

Alcoholic Intoxication↗
PubMed1995

Gallstone formation in obese women treated by a low-calorie diet.

This study assessed the incidence of gallstone formation in 47 obese women who consumed a low-calorie diet (LCD) for the first 16 weeks of a 26-week weight loss program. The LCD consisted of four daily servings of a liquid diet combined with an evening meal of a pre-packaged dinner entrée and provided approximately 925 kcal/d. Six of the 47 patients (12.8%) displayed gallstones at week 17, as determined by sonography. Five patients were asymptomatic when followed for up to 48 weeks. The sixth, however, reported severe abdominal pain 30 weeks after beginning treatment and required a cholecystectomy. Patients who developed gallstones, as compared with those who did not, had significantly higher baseline triglyceride and total cholesterol levels and had a significantly greater rate of weight loss. Results of this study indicate that an increased risk of gallstones is not limited to very-low-calorie diets and that the incidence of this complication should be assessed in persons who consume popular over-the-counter meal replacement plans.

Adult↗
PubMed1995

Dangerous delusions of misidentification of the self.

Delusions of misidentification of the self involve radical misidentification of physical and/or psychological aspects of the self. These delusions have received limited attention from a phenomenological as well as from a forensic psychiatric perspective. In this article we present a series of four cases of dangerous delusional misidentification of the self and discuss important factors that may contribute to their dangerousness.

Adult↗
PubMed1995

Another courtroom assault on the confidentiality of the psychotherapist-patient relationship.

The therapeutic and legal protections afforded by California's psychotherapist-patient privilege have become increasingly eroded in such recent cases as People v. Wharton and Menendez v. Superior Court. In another capital case, People v. Webb, the California Supreme Court further erodes this privilege in regard to the private (confidential) treatment records of a prosecution witness. The Webb case and its possible implications are explored.

Adult↗
PubMed1995

Psychiatric factors associated with dangerous misidentification delusions.

The delusional misidentification syndromes are characterized by misidentification delusions of others or of the self. Aggressive ideas or behaviors often accompany these delusions. The relationship between delusional misidentification and dangerousness remains for the most part poorly understood. In the present article, we compare a group of dangerous individuals suffering from dangerous misidentification delusions with a group of dangerous individuals suffering from other types of delusions. Individuals with dangerous misidentification delusions were more likely to experience grandiose ideation, thought disorder, generalized hostility, excitement, general psychopathology, and a previous history of violence than dangerous delusional individuals with no delusional misidentification. The group with dangerous delusional misidentification syndromes was less likely to attack others with weapons than were the dangerous delusional group with no delusional misidentification.

Adult↗
PubMed1995

Is liability possible for forensic psychiatrists?

Forensic psychiatrists are not as vulnerable to liability as general psychiatrists. The absence of a traditional physician-patient relationship and judicial and quasijudicial immunity are all protective against malpractice actions. Although the absence of a doctor-patient relationship removes an essential element of malpractice, other types of liability such as defamation and ordinary negligence are possible and may not be covered by malpractice insurance. A model is proposed for forensic psychiatry of a partial secondary doctor-patient relationship out-weighted in most circumstances by duties to truth and/or the hiring attorney. Such a model seems most consistent with conflicting duties currently forced on all psychiatrists. This model has advantages of a duty, a violation of which is likely to be covered by malpractice insurance. Rather than deemphasizing partial secondary physician-patient responsibilities, it is advised to stress the important protection provided by judicial and quasijudicial immunity.

Forensic Psychiatry↗
PubMed1994

Delusional misidentification syndromes and dangerousness.

Dangerousness in the delusional misidentification syndromes is studied by reviewing a sample of 82 cases defined by either verbal threats or physical violence caused by misidentification delusion. Eighty cases were obtained from a review of the anglophone psychiatric literature in which the patients exhibited some degree of dangerousness, to which we added 2 previously unreported cases.

Adult↗
PubMed1994

A cognitive model of dangerous delusional misidentification syndromes.

The hallmark of the delusional misidentification syndromes is the presence of a misidentification delusion of the self or others. Delusional misidentification may present with an increased risk for dangerous behaviors. Individuals suffering from delusional misidentification syndromes may express hostility in ways ranging from serious verbal threats to homicidal acts. The causes of dangerous misidentification delusions remain for the most part undetermined. In this article, we report a series of six cases of individuals who harbored dangerous misidentification delusions. These individuals were studied phenomenologically and forensically. They were also studied biologically, including neuropsychological testing. A cognitive hypothesis aimed at explaining dangerousness and delusional misidentification is proposed. Implications of the hypothesis for further research are briefly outlined.

Adult↗
PubMed1994

Utilizing therapists to obtain death penalty verdicts.

As a result of recent decisions by the United States and California Supreme Courts, therapists now have been placed in a position in which they can be forced to testify in death penalty cases for the only purposes of achieving a conviction and a death penalty verdict. Zeal for the death penalty seems to have overcome any concern for the ethics of psychiatrists or even for the welfare of society. In California, therapists can now be forced to testify against their own patients in capital cases even if the patient does not tender his mental state as an issue, despite the presence of a psychotherapist-patient privilege in the state for criminal matters. In California, the only option for therapists who wish to treat potentially dangerous patients may be to conduct the therapy under the umbrella of attorney-client privilege. Otherwise they may not be able to avoid serious ethical problems and personal danger if the patient actually does kill someone during or after therapy. They may be unable honestly and ethically to treat such patients without obtaining truly informed consent to therapy under these potentially "undercover policeman" circumstances. Hopefully, professional organizations will take a more activist position, and courts will appreciate the folly of these decisions and reverse them. Otherwise, they may spread to other states, for which California frequently sets precedents.

California↗
PubMed1993

Delusions of transformation of the self.

A series of 20 patients suffering from delusions of physical and psychological transformation of the self is studied. Nosological, psychosocial, and biological aspects are discussed. Two cases are presented in detail.

Adult↗
PubMed1993

Delusional misidentification and dangerousness: a neurobiologic hypothesis.

Delusional misidentification syndromes have intrigued this century's psychiatric researchers. More recently, the dangerousness posed by individuals suffering from these syndromes has been a subject of scientific inquiry. A series of five individuals suffering from delusional misidentification syndromes was studied from a phenomenologic and neuropsychologic perspective. Using this information, a hypothesis involving the psychobiological contributions to the dangerousness of delusional misidentification can be generated. This may further our understanding of the dangerousness posed by psychotic individuals.

Adult↗
PubMed1993

The psychotic patient as security guard.

The job of the security guard is generally regarded as stressful because of the potential for violent or other hostile confrontation. Although the public assumes that only mentally healthy individuals who possess the capability to handle stressful situations become employed as security guards, this may not be the case. A series of 15 individuals who suffered from psychotic disorders while working as security guards is studied and discussed in terms of the issues of dangerousness and public safety. One case is described in detail in order to highlight important issues resulting from being psychotic while working as a security guard.

Adult↗
PubMed1992

The dangerousness of persons with misidentification syndromes.

The central feature of misidentification syndromes is the presence of a delusion in which either the identity of the self or other persons is misrecognized. Recent psychiatric case reports have noted the dangerousness posed by persons with misidentification delusions. The authors report on a series of 29 individuals whose delusional misidentification was associated with aggressive behaviors. Important parameters which may assist in defining this sample of dangerous delusional misidentification syndrome persons are discussed.

Adult↗
PubMed1992

Dangerousness of the delusional misidentification of children.

Misidentification syndromes have been studied from a variety of perspectives, including phenomenological, biological, and nosological approaches. More recently, misidentification syndromes have been studied from a psychiatric-legal perspective, especially with regards to the problem of dangerousness. Capgras syndrome and other syndromes of misidentification can lead to hostile mood and subsequent physical violence. Little attention has so far been devoted to children as the objects of the psychotic person's misidentification delusion(s). We provide a review of cases from the anglophonic literature that have children as the misidentified objects, add three new cases, and then discuss the relationship between misidentification and potential harm to these children.

Adult↗
PubMed1992

The death penalty and Bernard Diamond's approach to forensic psychiatry.

Bernard Diamond would testify only for the defense in criminal cases, but only if the whole psychiatric truth would be introduced during a trial and the facts of the case supported the defense position. Otherwise, he would refuse to participate. Although few other forensic psychiatrists have personal or professional ethical concerns regarding ever participating for the prosecution, many more have such problems in capital cases. Bernard Diamond's approach to forensic psychiatry should be considered at least as an option by those opposed to the death penalty. Bias in capital cases is not a persuasive reason to withdraw from involvement if the forensic psychiatrist remains honest.

Capital Punishment↗
PubMed1991

Opinions by AAPL forensic psychiatrists on controversial ethical guidelines: a survey.

A survey was conducted of a sample of AAPL members to determine their opinions on the inclusion of controversial ethical guidelines for forensic psychiatry. Members appear to appreciate the need to consider traditional Hippocratic values as at least one consideration in their functioning as forensic psychiatrists. They appear to balance their duties to an evaluee with duties to society and the legal system and to appreciate the responsibilities of multiple agency. Support was shown for interpreting ambiguities in AAPL's current guidelines in the directions indicated by most of this survey's proposed guidelines.

Attitude of Health Personnel↗
PubMed1991

Misidentified political figures: an underappreciated danger.

A series of twelve patients is presented in which each patient suffered from one or more misidentification syndromes and also misidentified one or more political figures. The fact that misidentification syndromes have been associated with physical violence and that the majority of the patients studied had a history of physical violence suggests that these individuals could pose a significant danger of physical harm to others, including political figures. Persons who threaten political figures should be evaluated for misidentification syndromes.

Adult↗