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Behavioral Sciences & the Law Apr 2024With its firm establishment as a neuropsychology subspecialty, forensic neuropsychological assessment is integral to many criminal and civil forensic evaluations. In...
With its firm establishment as a neuropsychology subspecialty, forensic neuropsychological assessment is integral to many criminal and civil forensic evaluations. In addition to evaluating cognitive deficits, forensic neuropsychologists can provide reliable information regarding symptom magnification, malingering, and other neurocognitive and psychological issues that may impact the outcome of a particular legal case. This article is an overview and introduction to neuropsychological assessment in the forensic mental health context. Major issues impacting the current practice of forensic neuropsychology are summarized, and several examples from case law are highlighted.
PubMed: 38583136
DOI: 10.1002/bsl.2656 -
Neuropsychology Review Sep 2023Dr. Leonhard presents a comprehensive and insightful critique of the existing malingering research literature and its implications for neuropsychological practice. Their... (Review)
Review
Dr. Leonhard presents a comprehensive and insightful critique of the existing malingering research literature and its implications for neuropsychological practice. Their statistical critique primarily focuses on the crucial issue of diagnostic inference when multiple tests are involved. While Leonhard effectively addresses certain misunderstandings, there are some overlooked misconceptions within the literature and a few new confusions were introduced. In order to provide a balanced commentary, this evaluation considers both Leonhard's critiques and the malingering research literature. Furthermore, a concise introduction to Bayesian diagnostic inference, utilizing the results of multiple tests, is provided. Misunderstandings regarding Bayesian inference are clarified, and a valid approach to Bayesian inference is elucidated. The assumptions underlying the simple Bayes model are thoroughly discussed, and it is demonstrated that the chained likelihood ratios method is an inappropriate application of this model due to one reason identified by Leonhard and another reason that has not been previously recognized. Leonhard's conclusions regarding the primary dependence of incremental validity on unconditional correlations and the alleged mathematical incorrectness of the simple Bayes model are refuted. Finally, potential directions for future research and practice in this field are explored and discussed.
PubMed: 37594692
DOI: 10.1007/s11065-023-09604-4 -
Sleep Medicine Clinics Mar 2024Although many sleep-related behaviors are benign, others can result in physical or sexual aggression toward bed partners or others. Individuals who engage in... (Review)
Review
Although many sleep-related behaviors are benign, others can result in physical or sexual aggression toward bed partners or others. Individuals who engage in sleep-related violence (SRV) and sexual behavior in sleep (SBS) may face legal sanctions for their behavior. Attorneys or legal decision-makers may call on an expert to evaluate a defendant and opine about the veracity of an alleged parasomnia diagnosis, the criminal responsibility of the defendant, and his risk of violence to others. This article reviews the phenomena of SRV and SBS and guides evaluators in the forensic considerations relevant to parasomnias.
Topics: Humans; Parasomnias; Sexual Behavior; Sleep
PubMed: 38368065
DOI: 10.1016/j.jsmc.2023.10.010 -
Lancet (London, England) Feb 2024The cerebroplacental ratio is associated with perinatal mortality and morbidity, but it is unknown whether routine measurement improves pregnancy outcomes. We aimed to... (Randomized Controlled Trial)
Randomized Controlled Trial
Term planned delivery based on fetal growth assessment with or without the cerebroplacental ratio in low-risk pregnancies (RATIO37): an international, multicentre, open-label, randomised controlled trial.
BACKGROUND
The cerebroplacental ratio is associated with perinatal mortality and morbidity, but it is unknown whether routine measurement improves pregnancy outcomes. We aimed to evaluate whether the addition of cerebroplacental ratio measurement to the standard ultrasound growth assessment near term reduces perinatal mortality and severe neonatal morbidity, compared with growth assessment alone.
METHODS
RATIO37 was a randomised, open-label, multicentre, pragmatic trial, conducted in low-risk pregnant women, recruited from nine hospitals over six countries. The eligibility criteria were designed to be broad; participants were required to be 18 years or older, with an ultrasound-dated confirmed singleton pregnancy in the first trimester, an alive fetus with no congenital malformations at the routine second-trimester ultrasound, an absence of adverse medical or obstetric history, and the capacity to give informed consent. Women were randomly assigned in a 1:1 ratio (block size 100) using a web-based system to either the concealed group or revealed group. In the revealed group, the cerebroplacental ratio value was known by clinicians, and if below the fifth centile, a planned delivery after 37 weeks was recommended. In the concealed group, women and clinicians were blinded to the cerebroplacental ratio value. All participants underwent ultrasound at 36 + 0 to 37 + 6 weeks of gestation with growth assessment and Doppler evaluation. In both groups, planned delivery was recommended when the estimated fetal weight was below the tenth centile. The primary outcome was perinatal mortality from 24 weeks' gestation to infant discharge. The study is registered at ClinicalTrials.gov (NCT02907242) and is now closed.
FINDINGS
Between July 29, 2016, and Aug 3, 2021, we enrolled 11 214 women, of whom 9492 (84·6%) completed the trial and were eligible for analysis (4774 in the concealed group and 4718 in the revealed group). Perinatal mortality occurred in 13 (0·3%) of 4774 pregnancies in the concealed group and 13 (0·3%) of 4718 in the revealed group (OR 1·45 [95% CI 0·76-2·76]; p=0·262). Overall, severe neonatal morbidity occurred in 35 (0·73%) newborns in the concealed group and 18 (0·38%) in the revealed group (OR 0·58 [95% CI 0·40-0·83]; p=0·003). Severe neurological morbidity occurred in 13 (0·27%) newborns in the concealed group and nine (0·19%) in the revealed group (OR 0·56 [95% CI 0·25-1·24]; p=0·153). Severe non-neurological morbidity occurred in 23 (0·48%) newborns in the concealed group and nine (0·19%) in the revealed group (0·58 [95% CI 0·39-0·87]; p=0·009). Maternal adverse events were not collected.
INTERPRETATION
Planned delivery at term based on ultrasound fetal growth assessment and cerebroplacental ratio at term was not followed by a reduction of perinatal mortality although significantly reduced severe neonatal morbidity compared with fetal growth assessment alone.
FUNDING
La Caixa foundation, Cerebra Foundation for the Brain Injured Child, Agència per la Gestió d'Ajuts Universitaris i de Recerca, and Instituto de Salud Carlos III.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Fetal Development; Fetus; Perinatal Death; Pregnancy Outcome; Prenatal Care; Ultrasonography, Prenatal
PubMed: 38219773
DOI: 10.1016/S0140-6736(23)02228-6