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Temporomandibular Joint Dislocation Due To Atypical Antipsychotic-induced Acute Dystonia: A Case Report

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Introduction

Dystonia is a movement disorder that causes sustained muscle contractions, repetitive twisting movements, and abnormal postures of the trunk, neck, face, arms or legs [Fahn et al. 1987]. It may be focal, segmental (multifocal), or generalized and may also be primary or secondary based on their etiology. It may manifest as oculogyric crisis, deviation of eyes in all directions, protrusion of tongue, trismus, lock jaw, torticolis, laryngeal spasm, difficulty in speaking, facial grimacing, opisthotonus, lordosis or scoliosis and tortipelvic crisis. Drug-induced dystonia are secondary dystonias which occur commonly with drugs with antidopaminergic effects such as antipsychotics and metoclopramide [Ropper and Samuels, 2009; Fadare and Owolabi, 2009]. They reportedly arise from a drug-induced alteration of dopaminergic–cholinergic balance in the nigrostriatum (i.e. basal ganglia). Most drugs produce dystonic reactions by nigrostriatal dopamine D2 receptor blockade, which leads to an excess of striatal cholinergic output. High-potency D2 receptor antagonists are most likely to produce...

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Spoliation of Evidence

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The spoliation of evidence is the intentional, reckless, or negligent withholding, hiding, altering, fabricating, or destroying of evidence relevant to a legal proceeding.[1] Spoliation has three possible consequences: in jurisdictions where the (intentional) act is criminal by statute, it may result in fines and incarceration (if convicted in a separate criminal proceeding) for the parties who engaged in the spoliation; in jurisdictions where relevant case law precedent has been established, proceedings possibly altered by spoliation may be interpreted under a spoliation inference, or by other corrective measures, depending on the jurisdiction; in some jurisdictions the act of spoliation can itself be an actionable tort.[2]

The spoliation inference is a negative evidentiary inference that a finder of fact can draw from a party's destruction of a document or thing that is relevant to an ongoing or reasonably foreseeable civil or criminal proceeding: the finder of fact can review all evidence uncovered in as strong a light...

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False Memories And False Confessions: The Psychology Of Imagined Crimes

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It involved two sisters who, in 2015, had given the police vivid descriptions of being sexually abused by a close female relative. They alleged that the abuse had taken place between 1975 and 1976. The lawyer, who was representing the defendant, wanted Shaw's input as an expert witness.

Shaw, a criminal psychologist at the London South Bank University, was struck by how unusual the scenario was. "Usually, in cases of sexual abuse, the father is the accused," she says. "In this case, it was a girl." At the time of the alleged abuse, the sisters had been around four and seven years old, and the relative was between ten and 12.

As she leafed through the interview transcripts, Shaw noted the older sister's language. "She kept saying, 'My childhood was rough and I buried so much. I think it was my coping mechanism, I must have just blocked it.' ...

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The Origin Of Psychiatry:the Alienist As Nanny For Troublesome Adults

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Abstract

Discusses the historical, political, economic, and cultural origins of psychiatry. The author distinguishes between the origins of the medical and psychiatric professions, noting that medicine began with persons seeking relief from pain, while psychiatry began with persons seeking relief from the socially unacceptable behavior of their relatives, who were unwilling patients. The author argues that psychiatry was based on coercion and had nothing to do with healing. Madhouses are described as English inventions that were convenient to wealthy families and profitable to madhouse keepers. The role of clergy as madhouse keepers is addressed, highlighting the Western tradition of interpreting insanity in religious terms. Other topics discussed include critics of "madhousing" and "madhousing" as depicted in English literature. (PsycINFO Database Record (c) 2016 APA, all rights reserved)...

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Measuring the Performance of Law Enforcement Agencies – Part 1 of a 2-Part article

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I. INTRODUCTION

This is the first segment of a two-part article on measuring the performance of law enforcement agencies. It is written for a policing audience, and draws in part on my discussions with members of CALEA’s Performance Measurement Subcommittee and those who have attended my training workshops at the last two CALEA Conferences. In this first segment, I introduce the general concepts, terminology, and history of comparative performance measurement in policing. The second segment, which will appear in the next edition of the CALEA Update, will show you how to develop, pilot-test, and implement comparative performance measurement in your agency. This article is one small part of a larger effort by CALEA to explore the feasibility and utility of agency-level performance measurement in policing. That journey is just beginning, and will proceed slowly, but it is expected to be a worthwhile one...

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A Modified Labeling Theory Approach To Mental Disorders: An Empirical Assessment

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Abstract

Proposes a modified labeling perspective that claims that even if labeling does not directly produce mental disorder, it can lead to negative outcomes. The authors' approach asserts that socialization leads individuals to develop a set of beliefs about how most people treat mental patients. When individuals enter treatment, these beliefs take on new meaning. The more patients believe that they will be devalued and discriminated against, the more they feel threatened by interacting with others. Such strategies can lead to negative consequences for social support networks, jobs, and self-esteem. The authors test this modified labeling perspective using samples of psychiatric patients (n = 164) and 429 untreated community residents (aged 19–59 yrs), and find that both believed that most people will reject mental patients. Additionally, patients endorsed strategies of secrecy, withdrawal, and education to cope with the threat they perceive. (PsycINFO Database Record (c) 2016 APA, all rights reserved)...

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Reconstructing Homicide Events: The Role Of Witnesses In Fatal Encounters

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Abstract

Examinations of homicide have used both micro and macro level data to account for the interaction between victims and offenders. Missing from such analyses, however, is an examination of the role of witnesses or third parties present at homicide events. These individuals may play a variety of roles in homicide events including instigating, mediating, escalating, or facilitating fatal violence. Using St. Louis homicides for the years 1985–1989, this study provides a classification scheme for the roles of witnesses in homicide events...

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The Influence Of Forensic Evidence On The Case Outcomes Of Homicide Incidents

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Abstract

Objective In spite of the growth of forensic science services little published research exists related to the impact of forensic evidence on criminal case outcomes. The present study focused on the influence of forensic evidence on the case processing of homicide incidents.

Materials and Methods The study utilized a prospective analysis of official record data that followed homicide cases in five jurisdictions from the time of police incident report to final criminal disposition.

Results The results showed that most homicides went unsolved (34.5% conviction rate). Only 55.5% of the 400 homicide incidents resulted in arrest of which 77% were referred to the district attorney. On the other hand, 94% of cases referred to the district attorney were charged. Cases were more likely to have arrests, referrals, and charges when witnesses provided information to the police. Suspects who knew their victims were more likely to be arrested and referred to the district attorney...

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Retroperitoneal Injuries: Pitfalls In Diagnosis And Management.

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Abstract

Retroperitoneal injury caused by penetrating trauma or associated with progressive shock following blunt trauma is usually recognized promptly and managed appropriately. Isolated retroperitoneal injury from blunt trauma, unless accompanied by major hemorrhage or gross hematuria, is often difficult to diagnose and needed treatment may be delayed. Although clinical examination remains the cornerstone of diagnosis, the high incidence of ethanol abuse and/or concurrent head injury in trauma patients has led to increased use of computed tomography in the diagnosis of abdominal trauma. To determine the effect, if any, of CT examination on the diagnosis and management of retroperitoneal trauma, we reviewed our patient experience. During the 16-month period ending in April 1986, 135 patients sustained 177 retroperitoneal injuries (116 by blunt and 19 by penetrating trauma). There were 26 deaths (19% mortality). There were 90 pelvic fractures and 31 lumbar spine fractures, as well as 21 genitourinary, 12 gastrointestinal, five pancreatic, and eight major vascular injuries....

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Management Of Stab Wounds Of The Back And Flank

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Abstract

Abdominal stab wounds are managed on a selective basis with increasing frequency. Retroperitoneal injuries are more difficult to evaluate; hence wounds to the flank and back pose different considerations. A retrospective review of 108 patients with deep stab wounds of the flank and back was compared with a prospective study of 109 patients selectively managed with similar injuries. Physical examination was accurate in 86% of flank and 88% of back wounds. Local exploration was an effective procedure in differentiating superficial from deep wounds. Peritoneal lavage may be more accurate in flank wounds but is probably less reliable with retroperitoneal injuries. Adjunctive studies are helpful in selected patients. The incidence of negative celiotomies was reduced from 85.2% to 7.3% when the selective approach was adopted. There was no mortality or increased morbidity in the series. Although the risk of retroperitoneal injury is greater with flank and...

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Homicidal And Suicidal Sharp Force Fatalities: Autopsy Parameters In Relation To The Manner Of Death.

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Abstract

A retrospective, comparative study was carried out on 118 sharp force fatalities, including 70 homicides and 48 suicides, and covering a 22-year period from 1986 to 2008. The objective was to identify relevant parameters that may be used to distinguish between these two manners of death. The following parameters were analysed: age, gender, number of wounds, type of wounds, anatomical sites of the wounds, presence of wounds affecting bones or cartilage, the longitudinal axis of stab wounds located at the anterior part of the trunk, Injury Severity Score (ISS) and associated traumatic injuries. Our statistical analyses revealed several relevant parameters that may help differentiate the two manners of death. Homicide victims were younger than those who had committed suicide. Homicide cases showed associated stab and cut wounds, whereas suicide cases predominantly showed isolated cut wounds. Wounds located at the head, limbs, hands, nape of the neck, or back were predictive of a homicide,...

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Multiple Stab Wounds: A Short-term Respiratory Case Study.

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Abstract

Respiratory management is a role that is of paramount importance to intensive care nurses. Proactive nursing allows a nurse to have a positive effect on a patient's condition by actively improving the patient's status and setting priorities of care, avoiding deterioration wherever possible. In this account of the respiratory management of a patient who has sustained bilateral pneumothoraces following multiple stab wounds to the chest and back, the physiological assessment of the patient is described and a proactive respiratory plan of care is formed. Anatomy, physiology and pathophysiology in relation to pneumothoraces, metabolic acidosis and magnesium links with functional residual capacity are addressed. The potential risk of Adult Respiratory Distress Syndrome (ARDS) following direct and indirect lung injury is discussed. Recent research into ventilation modes and into areas of nursing practice relating to respiratory management are also considered....

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Diagnostic Utility Of Postmortem Fine-needle Aspiration Cultures.

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Abstract

BACKGROUND: Microbiological cultures at autopsy have not proved to be very useful. In life, transthoracic and fine-needle aspirations of other tissues have provided better results. The aim of this prospective study was to assess the diagnostic utility of postmortem cultures obtained by fine-needle aspiration puncture (FNAP) of several tissues when punctures were performed in the immediate postmortem period.

METHODS: Comparative analysis was performed between FNAP cultures and those obtained in life and by conventional autopsy. All adult autopsied patients who died at a general teaching hospital in a 3-year period were included. Clinical data, microbiological cultures before death, and pathologic data from autopsies of all patients were recorded, as were results of FNAP performed after death from the heart, right lower lung, liver, spleen, and other areas suspicious for infection. Cultures from the same sites were made at autopsy. Microorganisms were isolated and defined as infectious agents, colonizers, or contaminants according to standard criteria.

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The Management Of Penetrating Injuries Of The Back. A Prospective Study Of 230 Patients.

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Abstract

This is a prospective study of 230 patients with penetrating injuries of the back. The decision to operate or observe was taken exclusively on the abdominal physical findings. One hundred ninety-five patients (85%) did not require operation, 30 (13%) underwent a therapeutic laparotomy, four (1.7%) an unnecessary operation, and one patient (0.4%) had a completely negative laparotomy. The diagnosis and management was delayed in five (2.2%) patients with no serious consequences. Mortality rates were not recorded in this series. The initial physical examination was accurate in 95.2% of the patients. We suggest that penetrating injuries of the back should be assessed in the same way as anterior abdominal injuries. Physical abdominal examination is reliable in detecting significant intra-abdominal injuries. '''

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Fantasies of Female Serial Killers

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Police come to me when they have cases where they suspect a woman of serial murder. I am the expert on the topic having interviewed a large group of female serial killers back in the 1990's. From those interviews and studying their murders, I created the profiles of female serial killers. To this day, such a case is the most difficult type of homicide to work. People are reluctant to believe a woman could be so violent, and these women offenders are careful in the way they kill. They use covert murder methods such as asphyxiation or poisoning to kill, and they chose victims who are easy to kill.

People are even less likely to consider that females fantasize about killing. However they do! When I interviewed the female serial offenders, I learned a great deal. First, fantasy is an elaborate set of cognitions...

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How To Read A Stab Wound

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Most emergency departments do not see much penetrating trauma. But it is helpful to be able to learn as much as possible from the appearance of these piercing injuries when you do see them. This post will describe the basics of reading stab wounds.

Important: This information will allow some basic interpretation of wounds. It will not qualify you as a forensics expert by any means. I do not recommend that you document any of this information in the medical record unless you have specific forensic training. You should only write things like “a wound was noted in the midepigastrium that is 2 cm in length.” Your note can and will be used in a court of law, and if you are wrong there can be significant consequences for the plaintiff or the defendant. This information is for your edification only.

1. What is the length of the wound? This does not necessarily...

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