Assessing stressful life events in relation to liability and compensation

Psychiatry's problem child: PTSD in the forensic context: (part 1)

OBJECTIVE

The aim of this paper was to consider some of the recent literature that has raised questions about the prevalence of, and problems with, post-traumatic stress disorder (PTSD) in the forensic context and whether it is a failure by experts to consider adequately Criterion A (1), which leads them into error and results in a skewed picture of the prevalence of PTSD in litigation.

METHOD

The nature of the stressor criterion for PTSD from DSM-III to DSM-IV-TR, and recent literature relating to problems with the manner in which that stressor criterion is applied in forensic contexts, are considered.

RESULTS

It becomes clear that, notwithstanding that the class of persons who can suffer PTSD after a particularly traumatic event has widened since it was included in the DSM-III, the nature of the stressor required before a diagnosis of PTSD can be made has remained fairly constant.

CONCLUSIONS

Whether it is because PTSD is commonly associated with receiving a benefit (e.g. through post-war disability benefits, victims of crime compensation or because of a desire to use it as an ideological weapon), PTSD has become a ubiquitous presence in the forensic context, notwithstanding objective (i.e. non-forensic) clinical studies which refer to its rarity. It is clear now that PTSD symptoms can be readily simulated when the simulator is seeking a benefit. It is also becoming clear that some psychiatrists are not being as rigorous in the forensic context as they might be in a clinical context. Thus, with discussion now underway regarding DSM-V, it may be timely to reconsider the utility of PTSD as a clinical condition.

A consideration of the relationship between the Rules of Court and the Code of Ethics in forensic psychiatry

OBJECTIVE

To consider the relationship between the Rules of Court for expert witnesses and the revised Ethical Guideline No. 9 and Practice Guideline No. 9 of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) and how this affects the responsibilities that psychiatrists have to a court and to their profession, when they enter the legal arena.

METHOD

Literature relevant to the subject, the Federal Court rules relating to expert witnesses and the RANZCP Guidelines are discussed and compared, with examples used to illustrate particular issues that arise from time to time in the civil jurisdiction. A distinction is drawn between the functions of those psychiatrists who undertake forensic assessment and those who undertake clinical work, and some of the ethical challenges facing forensic psychiatrists are considered.

RESULTS

The Rules of Court relating to expert witnesses and the RANZCP Guidelines No. 9 have a complementary relationship and are thus ethically consistent with each other and provide a basis for psychiatrists to maintain and enhance the integrity of their profession.

CONCLUSION

Forensic psychiatry is a particularly complex medical speciality and one that can create enormous personal conflict for clinicians, especially those who are not forensic consultants. It may therefore be time for the College to develop an accreditation process for those prepared to undertake further study in the nature and practice of forensic psychiatry.

Life events, stress and depression: a review of recent findings

OBJECTIVE

To review recent empirical prospective studies on the relation between life event stressors and depression.

METHOD

A systematic literature search focusing on predictive studies was carried out from 1980 to early 2001 using Medline, Embase and PsychInfo.

RESULTS

The empirical findings for the most part support clinical impressions of the relation of stressors to depression but at the same time provide some clearer understanding in relation to differences of stressor impact on depression type and on index episode, relapse or recurrence. Twin studies now provide the strongest evidence of the relative magnitude of effect of environmental stressors and genetic factors: the former explains at least as much of the variance in depression as our genes.

CONCLUSIONS

Continuing research into life events and depression have been fruitful especially those studies assessing the effect of stressors in combination with other aetiological variables such as genetic factors.