A Guess Isn’t Good Enough for a Jury

If psychiatric damages are suspected, you will need solid information to present to a jury.

Why a Forensic Psychiatrist?

A Forensic Psychiatrist is granted Board-Certification only after receiving extensive training in the application of medical skill in psychiatry applied to legal questions. Psychiatrists without forensic training may miss what’s important in the medico-legal overlap.

Best Representation of Your Client

Cases can, and do, proceed without expert assessment. This decision deprives the triers of fact–and attorneys–of necessary information to understand damages and value the case, going into trial or settlement discussions.

Evaluate your case in light of reliable information and opinions, not guesses

Call Dr. Adhia: Free Consult

Let’s talk about your case.

 

(832) 746-5905

 

DIAGNOSIS AND PROGNOSIS

There is no substitute for diagnosis.

Dr. Adhia evaluates in light of a bigger picture that encompasses events, preexisting conditions, associated physical injuries and malingering (lying for secondary gain, such as money.)

Objectivity is the cornerstone of Dr. Adhia’s practice. He relies on years of training and experience to determine medical findings founded in hard science and skill.

How?

Dr. Adhia synthesizes a close review of information:

• Medical records
• Doctor reports
• Review of deposition testimony
• Neuropyschological Testing and Neuroimaging (if brain injury is suspected)
• Clinical Independent Medical Evaluation (IME), face to face with the examinee, if he believes it applicable and will contribute valuable information to his findings.
• Interviewing collateral informants (e.g. spouses, partners, friends who have knowledge of psychiatric conditions, behavior, changes in behavior or other observations relevant to forensic opinion).

Prognosis

If Dr. Adhia finds psychiatric damages, he addresses prognosis – efficacy of treatment.  Can there be restoration of a psychiatrically injured party to mental health. What treatment is indicated? How much is it likely to cost?

Impact on the family

A psychiatric condition can impact an individual’s family, employment and quality of life when it begins and in the future. For that reason, prognosis informs a network of legal and personal support.

Alarming Trend in Self-Diagnosis

Do you want to rely on Wikipedia to stand up in Court? 

Diagnosis by a layperson is a dangerous trend in public thinking, “Armchair Psychology.” Further, a litigant has an emotional investment and may feel urgency to put into words what they believe they are experiencing–even if they don’t understand the words they are using. Emphasis on “belief.” The internet and buzzwords have become go-to terms that suggest anyone is qualified to diagnose a medical condition.  Attorneys for plaintiff and defense should be alert when they hear something like this:

“I am depressed”

“I have PTSD”

“I am afraid all the time”

“I don’t remember things like I used to”

“I’m an emotional mess, this has ruined my life”

“Mom had dementia, she could never have changed her Will.”

“He said he was too depressed to leave the house but I heard he was at a party last week.”

“I knew exactly what I was doing. I’m not insane. They’re always saying I lie.”

“She’s crazy. She can’t be trusted to handle responsibility.”

“But for …I wouldn’t have these problems.”

Litigation exists where there’s a cause-and-effect belief.  If liability is proven then damages are compensable. What if Psychiatric damages are misunderstood by a non-professional, and thus misrepresented.

A layperson is not qualified to determine if a medical condition is existent or non-existent and the complications that give lie to that simplification. The layperson can be a litigant or an attorney struggling to determine the damages for emotional distress.

Subjective “belief” is not necessarily reality. 

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BRAIN INJURY

Brain function is complicated. Even a mild  “insult” can have a psychiatric impact on the sufferer.  (“Insult” is a medical term for injury, e.g., Concussion, Traumatic Brain Injury/TBI.)

The brain is so complex that sub-specializations like Brain Injury Medicine have developed.

Dr. Adhia developed his interest in Brain Injury Medicine when working on cases where he suspected psychiatric conditions masked or were confused by a brain injury. As a Forensic Psychiatrist, not a neurologist, he decided to pursue Board-Certification in BIM because of his natural interest in the field and desire to conduct forensic evaluations with added skill.

Are Psychiatrists qualified to practice Brain Injury Medicine?

The short answer is that Psychiatrists receive training in brain injuries but not to the greater depth of Board-Certification in Brain Injury Medicine.

Brain Injury Medicine is a subspecialty of Physical Medicine and Rehabilitation while Psychiatry is an independent and primary specialty.

Forensic Psychiatry is a subspecialty of Psychiatry, granted after fellowship training and examination, which Dr. Adhia completed in 2014. Forensic Psychiatrists must complete a high standard of continuing education including caselaw impacting expert testimony.

All 3 disciplines require examination (testing) and a rigorous regimen of continuing education.

Dr. Adhia’s training in Brain Injury Medicine (Physical Medicine and Rehabilitation,) Psychiatry and Forensic Psychiatry enable him to identify crossover conditions, symptoms and treatment, as they apply to matters adjudicated in the Court.

Physical Medicine and Rehabilitation doctors are trained in long-term rehabilitation, useful in a forensic/legal setting to determine prognosis and address the costs of treatment, e.g., Monetary Damages should liability be proven. Dr. Adhia’s training and credentials make him better suited to contribute this information to a trier of fact than someone who does not have this training and qualifications.

Psychiatrists and neurologists receive neurological education in medical school and residency. Similarly, neurologists receive some education in psychiatry. They are different disciplines which share study of the brain and its impact on our lives, physical and emotional.  And intertwined.

Injuries to the Brain, Medical and Legal Records

Dr. Adhia’s review of medical records requires a physician’s qualifications Medical records that accompany a physical injury can include hospitalization and treatment notes, radiology, MRIs and CTScans, test results, neurology reports and labwork. A Medical Review Officer has additional qualifications to consider toxicology reports.

Legal records are also relevant and can contain clues helpful to Dr. Adhia’s work. For example, reviewing the deposition testimony of other medical experts addressing brain function can be revealing inasmuch as they may report medical information not found in other records and worthy of further investigation.

What if a Forensic Psychiatrist's opinions are limited by a lack of deeper understanding of the brain?

Brain and Mood, Behavior and Mental Performance

A Traumatic Brain Injury (TBI) or Mild Brain Injury (mTBI, a different diagnosis), can develop into Chronic traumatic encephalopathy (CTE). We have seen this with victims of repeated concussion, athletes in contact sports or victims of persistent physical abuse. A single incident which results in a brain injury may have the same results: assault, an accident, even a fall can result in a brain injury. It may not develop into a permanent condition but any brain injury may accompany changes in behavior and mood, mental performance–clarity of thought, decision-making, even interpretation of “reality.”

Brain Injury Medicine is described on the site of the ABPMR which partners with the American Board of Psychiatry and Neurology to grant BIM Board-Certification. 

PSYCHOPHARMACOLOGY

Dr. Adhia has treated and evaluated drug use, and the impact of misusing doctor-prescribed and over the counter pharmaceuticals.

Drugs introduce symptoms that impact psychiatric diagnosis. 

Pharamaceuticals may interact with illegal substances, or each other, in unexpected ways. Dr. Adhia has been faced with examples in case after case.

Toxic substances can be developed by the body in response to a physical illness, impacting the brain.  Pharmacology refers to pharmaceuticals. However, toxic substances need not be ingested to do damage.  In a criminal matter described in a case study, an alcoholic’s liver failure and brain injury created a toxic and mentally impaired environment considered by Dr. Adhia as part of his competency evaluation.

Medical Malpractice and Prescription Medication

In clinical practice, a psychiatrist may prescribe medication as part of a treatment regimen. In fact, the licensing to prescribe is one of several distinctions between a psychiatrist and a psychologist. (Check out “Psychiatrist vs. Psychologist.”)

Drugs as a Weapon

Dr. Adhia’s article “Date Rape Drugs: Weaponized Chemistry” provides an interesting introduction to how drugs manipulate behavior and an overview of what drugs are most often used by perpetrators and how the drugs operate.

ADDICTION and SUBSTANCE ABUSE

Psychopharmacology is the underpinning of Addiction Medicine. Dr. Adhia has forensically evaluated, opined and treated addicts.

Addictive Drugs and Substances (partial list)

  • Addictive Pain Medications (Oxycontin, Vicodin)
  • Addictive Anxiolytic Medications (Benzodiazepines often used to treat anxiety,e.g. Xanaz, Valium and Clonazepam/Klonopin)
  • Opioids (pills, heroin)
  • Alcohol
  • Cocaine
  • Methamphetamines
  • Cannabis (marijuana and chemical variants of THC, also synthetic cannabinoids like k2, spice, kush)
  • Synthetics (Bath Salths, N-bomb)
  • Hallucinogens (LSD, Psilocybin, PCP)
  • Tobacco (cigarettes, cigars, chewing tobacco, E-cigarettes/vaping that contain a nicotine vapor.)

Psychopharmacology is the study of the effects of drugs on the mind and behavior. 

There are broad families of medications including:

  • Anti-Depressants – for both depression and Anxiety. (e.g., Prozac).
  • Anxiolytics – for anxiety. (e.g., Xanax).
  • Mood Stabilizers – used in bipolar and for anger (i.e Lithium). Some mood stabilizers are used in epilepsy as well.
  • Anti-psychotic – used in schizophrenia and for mood disorders (e.g., Abilify)
  • Stimulants – used in ADHD (e.g, Adderall)

There are other categories of medications. Each of the categories above may have subcategories. Illicit substances (not categorized above), would fall into the purview of psychopharmacology.

Experts in psychopharmacology would include psychiatrists and pharmacologists who specialize in psychiatric medications. 

Of interest: https://blog.frontiersin.org/2017/03/01/frontiers-in-psychiatry-launches-a-new-section-psychopharmacology/

PRESCRIBING MEDICATION

Doctors must obtain federal authorization to prescribe medication under the Drug Enforcement Administration. The DEA authorizes clearance to prescribe medications in Schedule levels 1-5 based on the addictive characteristics of a drug.

For example, “Schedule I drugs, substances, or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse. Some examples of Schedule I drugs are …heroin, lysergic acid diethylamide (LSD), 3,4-methylenedioxymethamphetamine (ecstasy)…”  (DEA Drug Scheduling https://www.dea.gov/drug-scheduling)

Schedule V drugs, on the other hand are very different.

“Schedule V drugs, substances, or chemicals are defined as drugs with lower potential for abuse ..antidiarrheal, antitussive, and analgesic purposes. ” (DEA Drug Scheduling https://www.dea.gov/drug-scheduling)

The US Department of Substance Abuse and Mental Health Services Administration issues a further waiver to prescribe the highly addictive substance Buprenorphine.

Dr. Adhia holds the Buprenorphine Waiver and is therefore legally approved to prescribe Buprenorphine if medically indicated. 

Better understand the Buprenorphine Waiver.

PHYSICAL EVIDENCE 

To prove the presence of drug use in an individual, a toxicology report may be indicated. This is typical in cases involving drug or alcohol abuse–most commonly with a DUI. However, when a victim is drugged, a toxicology report on the victim can reveal more about drug(s) used, and better understand the impact on the victim.

A Medical Review Officer (MRO) receives training to interpret these reports. Dr. Adhia has received Medical Review Officer training and expects certification by early 2020.

CRIMINAL / CORRECTIONAL

Standard of Care

Treating the most mentally ill and violent prisoners in the Texas Department of Justice, Dr. Adhia served as a Psychiatrist at the Beauford H. Jester IV Psychiatric Unit, a correctional psychiatric hospital, where he treated incarcerated men, including those in isolation (Ad. Seg.). He also treated at the supermax Polunsky Unit which houses Death Row and other offenders.

Psychiatric conditions were sometimes associated with imprisonment or may have contributed to committing a violent crime, including cellmate murder while imprisoned. Preexisting mental illness was also diagnosed and treated by Dr. Adhia.

Impulse Disorders are disproportionately present in a prison population than the general public. For this reason an Impulse program was developed and Dr. Adhia served as the primary treating psychiatrist.

Impulse Disorders are not exclusive to criminal behavior. 

Dr. Adhia’s patients included those with unusual psychotic disorders such as schizophrenia, with hallucination and delusions.  

Suicide and self-injurious behavior was a significant concern in prison and Dr. Adhia treated inmates exhibiting Self Injurious Behavior and those with Suicide Attempts. Self Injurious Behavior could be triggered by personality disorders or psychosis. Self Injurious behavior can include cutting, banging one’s head against a wall or intentionally seeking pain. Dr. Adhia writes further about these issues, as well as malingering, in greater detail on this page..keep reading.

 Note, “Jail” is a correctional facility which is used to describe short-term incarceration at a local law enforcement level and may follow charge with a crime. Dr. Adhia’s experience includes assessment of jailed inmates.

 A note about competency: Dr. Adhia has conducted dozens of NGRI competency evaluations when relevant in a criminal allegation.  He also worked as a treating psychiatrist on a competency/restoration unit.

Violent Crime

Dr. Adhia has conducted more than 50 evaluations in a criminal setting and is recognized for his skill in correctional psychiatry. He has worked on cases in military court and criminal defense.  Dr. Adhia consulted in an unusually complex case including a Capital Public Defendant charged with a triple-homicide, and a high profile case of homicide (matricide).

Sexual Assault

In the past year, Dr. Adhia served as an Expert Witness in cases involving use of date rape drugs, and sexual assault in civilian and military cases.

Standard of Care in Prisons vs. Hospitals, Clinics or Private Care Facilities

Standard of care in a private setting, such as an addiction rehabilitation facility may require a different assessment by Dr. Adhia than in a correctional setting. Prisons and hospitals have unique institutional protocols and restrictions on treatment options.  Keep reading below about Standard of Care in Institutions and facilities which are not in the correctional setting.

MEDICAL-MALPRACTICE. STANDARD OF CARE IN HOSPITALS, PRIVATE PATIENT CARE, IN-PATIENT AND OUT-PATIENT TREATMENT.

Examples of medical care facilities and Institutions that must meet Standards of Care

Hospitals and Urgent Care Centers.

Addiction Rehabilitation Treatment centers. Most require patients to live onsite during treatment (In-Patient).

Out-Patient Behavioral Health Clinics. These include psychiatric or psychological treatment clinics for mild or severe mental disorders including psychotherapy with or without medication management. Such clinics may serve a particular community or geographic area. If a unique condition is treated, patients may not live locally.

Assisted Living Facilities where Medical or Nursing Services are provided onsite or on-call.

“Wellness” or Spas that Provide Medical Treatment.

In-Patient Mental Health Treatment Centers. In-patient treatment describes hospitalization or treatment which requires the patient live at the treatment location.

Post-operative recovery in a private clinic. 
We see this in some Plastic Surgery “clinics” that advertise recovery facilities that are in a hotel or luxury apartment with nursing and/or medical staff available.

Standard of care in a private setting, such as an addiction rehabilitation facility is assessed differently by Dr. Adhia than in a correctional setting.

Prisons and hospitals have unique institutional protocols and restrictions on treatment options.

A rehab facility, however, may offer a different in-patient experience than a hospital. Some facilities promote the luxury and convenience they offer. Whether medical staff credentials are equal to rehab treatment, however requires a closer look if side effects from withdrawal create a medical emergency.

On the other hand, a hospital usually has strict treatment protocols which, if not followed may impact the standard of care.

Similarly, best practices and medical training, treatment consistent with protocols can result in a different interpretation of a seemingly egregious “mistake.”

The Doctor-Patient Relationship. Has Medical-Malpractice been Committed?

The relationship between doctor and patient, whether or not it is psychotherapy, is governed by ethical and legal obligations. Doctors are required to maintain professional “arm’s length” treatment. Crossing the boundary can include developing an emotional or sexual relationship between treater and patient. In general patient care, however, touching not indicated by medical treatment (e.g. hugging) may not withstand scrutiny.

Medical malpractice may not have been committed. Individuals with some psychiatric disorders or personality types may misinterpret what is appropriate treater behavior.  Also, professional standards of care are not always understood by patients. What they may think is malpractice in fact is within ethical and legal lines.

My case study, Medical Malpractice: Therapy Gone Terribly Wrong, or Did It? on this topic offers a real-world example and what I determined on forensic examination.  Learn More…

TRAUMA, TRAUMATIC EXPERIENCES, DISABILITY AND PTSD

PTSD

PTSD is commonly brought up in litigation, as exposure to trauma is required for its diagnosis, in contrast to other disorders. In his work with victims of human trafficking through Physicians for Human Rights, Dr. Adhia has conducted forensic assessments which, not surprisingly, include PTSD. He has spent much of his training in VA settings where he treated combat-related PTSD.

If you suspect your client has PTSD

Call Dr. Adhia to discuss if a closer look is necessary for proper diagnosis. Other conditions can appear that mimic PTSD, and PTSD contains elements of other conditions.  Misdiagnosis is a danger. As a damages expert, Dr. Adhia can testify to diagnosis, prognosis and treatment of PTSD.

PTSD treatment can require a long-term regimen including medication and a constellation of treatment approaches.

PTSD is diagnosed by a Psychiatrist. PTSD does not appear randomly. PTSD may derive from an injury or event so severe that it ends up in Court. If the catchall of “emotional distress” proves to be PTSD, a Forensic Psychiatrist is the right Expert to make that call. The diagnosis of PTSD is not required to proceed with your case.  Events can cause other psychiatric disorders that are confused with PTSD including Adjustment Disorder and other trauma-related disorders like Generalized Anxiety and Depression.

DISABLING PSYCHIATRIC TRAUMA AND COLLATERAL FAMILY DAMAGE

Dr. Adhia provides Pro-Bono assessments for Physicians for Human Rights, evaluation victims of human trafficking and sexual slavery. Human trafficking is a severe relative of kidnapping. Victims isolated from their liberty and family may manifest a range of symptoms and severe psychiatric conditions.

Emotional Trauma PTSD Anxiety and Depression

TRAUMA AND RESPONSE TO TRAUMATIC EVENTS

Dr. Adhia’s experience includes forensic assessment of the psychiatric impact of violence committed over an extended period. Victims of elder abuse, for example, may experience manipulation or even violence when a physically incapacitated person is essentially “under house arrest” by family and caregivers.

Response to trauma is experienced differently by each person.  Resilience can play a part, as can unusual vulnerability.  Vulnerability can include a limited ability to adapt to new circumstances, pain threshold, injuries, brain injuries, Dementia or Alzheimer’s Disease. For example, the mentally impaired elderly person exposed to trauma may be less able to cope.

Be on the alert for:

Personality Changes

Social Withdrawal

Debilitating fearfulness of objects and actions associated with the trauma (won’t drive, afraid to sleep, won’t go outside.)

Rejection of Support or Treatment

Misperception of reality during a hallucination.

Suicidal thoughts or actions

 

MOOD DISORDERS / ANXIETY DISORDERS

A Mood Disorder is a category of illness marked by an unexpected or serious change in mood.

A few of the most familiar types of Mood Disorders are discussed here.

A common type of damages asserted in a civil Complaint are “Emotional Distress.” Emotional Distress sounds broad.  However, the nature of “distress” that is “emotional” begs the question: has a Mood Disorder developed in response to the events that have led the matter into Court.  Causation is for the trier of fact to determine. The presence of Emotional Distress must be determined by a Forensic Psychiatrist and symptoms begin to tell the story.

ANXIETY DISORDERS

Anxiety involves excessive worrying and fear.  Anxiety disorders include Generalized Anxiety Disorder marked by a general overarching worry even when worrisome situations or events are not present. Other Anxiety Disorders include Panic Disorder, Obsessive Compulsive Disorder (OCD), Social Anxiety Disorder. Anxiety Disorders and Major Depressive Disorder or PTSD can occur together though they are not the same diagnostically.

Real life examples of how an Anxiety Disorder might appear are:

  • Job interview causes irrational level of fear (Social Anxiety Disorder)
  • Mild confrontation produces a fight or flight level of Panic Disorder.
  • Repetitive behavior is necessary to complete a simple task like open a door or turn out a light. OCD is characterized by anxious fear that something terrible will happen if the obsessive-compulsive ritual is not carried out.
  • Symptoms appear randomly, like a feeling that you can’t breathe.

Anxiety Disorders and their symptoms are described in nearly 100 pages of the DSM5. As a Forensic Psychiatrist, Dr. Adhia is trained to identify and diagnose Anxiety Disorders. In a forensic setting, Dr. Adhia has evaluated malingered Anxiety.

What you may think is going on

The layperson, (i.e. the public, a juror, an attorney) may be influenced by popular commentary about what Mood Disorders are common. (“Armchair Psychology” is discussed on this page.)  The frequency of a particular Mood Disorder in the population is not the same as the public perception.

 

DEPRESSION AND ANXIETY

After an injury, Depression and/or Anxiety can develop. This does not mean there is a cause and effect relationship. Note that Depression is a Mood Disorder.

Anxiety Disorders are not Mood Disorders. All anxiety disorders fall in a single diagnostic category in the DSM51, the Diagnostic and Statistical Manual of mental disorders. PTSD is an anxiety disorder as is Generalized Anxiety Disorder.

Diagnosis is the first step. There may be no clinical depression, for example, though symptoms are reported.

Treatment options can minimize the long term impact on the plaintiff or defendant. Treatment can mitigate damages.

What can make Depression or Anxiety worse?

Pain.  In the case of a personal injury, chronic pain can make recovery difficult and depression more disabling.

Preexisting vulnerability to depression or anxiety.  An “eggshell psyche” is a medical term for an individual who is at greater risk by virtue of a personality or mental health disorder.

Exacerbating events. An injury, events with strong emotional impact, relationship problems, the death of a loved one.  In Wrongful Death cases, watching the death of a loved one is considered by law as a separate category than losing a loved one alone.

BIPOLAR DISORDER I AND II

Dr. Adhia diagnoses and treats Bipolar Disorders.  Bipolar Disorders are notoriously difficult to treat, especially with a medication regimen. Notably, once managed, an emotionally turbulent or stressful event such as those that end up in Court, can cause a Bipolar Disorder to again become disabling and resistant to a regimen of treatment that worked previously.

Any stressor, or trauma, can make a pre-existing Bipolar Disorder  worse. Examples are motor vehicle accidents, divorce, abuse, sexual assault.

Bipolar Disorder is marked by extreme highs and lows: 

Mania (hyperactivity, inability to sleep, speaking fast, thinking unusually fast, rushing through things)

Hypomania (a less severe mania)

Depression

Mixed Episode where features of Bipolar Disorder occur in close proximity.

 

PERSONALITY DISORDERS

Psychiatrically, a Personality Disorder is a diagnostic condition in which the individual’s personality is pathological or medically significant.

The DSM5 1 identifies 10 distinct Personality Disorders. To make a diagnosis, a psychiatrist considers if symptoms meet criteria that meet the diagnostic threshold. He or she relies on clinical evaluation and medical background. Malingering the symptoms is is known to occur. Lastly, criteria and symptoms do not always reflect publicly-held assumptions. Common personality disorders encountered in medico-legal settings is Antisocial Personality Disorder and Borderline Personality Disorder.

IMPLUSIVE BEHAVIOR.

Dr. Adhia has treated and diagnosed Impulse Disorders which are not Personality Disorders. Personality Disorders like Borderline Personality Disorder may accompany impulsive behavior. Impulse Disorders are evidenced by a lack of control over emotions and behavior.

EXAMPLE: Borderline Personality Disorder.

Borderline Personality Disorder includes a constellation of symptoms.  In the med-legal environment, Dr. Adhia is sensitive to all elements, if this is his Diagnosis.  

BPD is marked by self-image issues, difficulty managing emotions and behavior, a pattern of unstable relationships.  Often we see self-injurious behavior, anger, impulsivity and impaired interpersonal and occupational functioning. Frequent changes in jobs or inability to get along with co-workers appropriately may accompany BPD.  Self-injurious behavior can include cutting one’s self and non-lethal suicide attempts. Self-image and self-injurious behavior may combine to manifest as an eating disorder such as bulemia or intentional starvation to lose weight. 

Impulsive Behavior.  Dr. Adhia has treated and diagnosed Impulse Disorders. Impulse Disorders are not Personality Disorders. Impulse Disorders are evidenced by a lack of control over emotions and behavior.

EXAMPLE: Paranoid Personality Disorder.

Misinterpretation of the actions of others through a paranoid lens might lead a person to seek litigation to prove their perceptions are accurate or punish another for actions which appear to them to be malicious. In some cases, Paranoid Personality Disorder may appear to be malingering (intentional lying.)

PPD is better described as a closely-held belief system that is not based in reality. 

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

MALINGERING

What is Malingering?

“Malingering” is intentional lying for personal gain.  Common motivations are financial gain, to become enriched as the result of a lawsuit, for example. An attorney or doctor should not assume all malingering is for self-gain. Psychiatric conditions can cause a person to misinterpret or reinvent a closely held belief of what is “true.” 

Any clinical examination by a Forensic Psychiatrist includes assessment of malingering. It is an important part of the Fellowship requirement for Board-Certification in Forensic Psychiatry.  Detecting Malingering is a feature of fellowship training. A significant proportion of Board Certified Forensic Psychiatrists were “grandfathered” in before completion of a Fellowship was required.  Attorneys who retain fellowship-trained Forensic Psychiatrists can be assured they are educated about detection of malingering.  Even many years after fellowship, this skill deepens with experience and in med-legal work, it is essential. Dr. Adhia has been assessing malingering for more than 5 years in his forensic practice. 

Dr. Adhia is skilled in assessing malingering.  In a high profile case involving men who posted on You Tube video of their rape of young girls, Dr. Adhia was asked to evaluate one of the men regarding competency to stand trial. The man suffered a brain injury as a young child which he cited in the competency matter. After two examinations and extensive assessment, Dr. Adhia’s conclusion was that the man was malingering. Read more…

Personality Disorders and Malingering: Diagnostic Concerns

Malingering: Lying vs. Perception vs. “Reality”

What appears to be malingering can instead be inconsistent statements due to other psychiatric conditions. This might look like lying. 

Proper diagnosis is essential.

Malingering is best assessed in conjunction with an Independent Medical Examination (a face to face clinical examination) to evaluate the examinee in light of records, other statements and neuropsychological testing, should it be indicated.

Other Factors to Consider:

Brain Injuries can impact a person’s ability to assess reality.

  • Amnesia which can be short term, long term, permanent or undefined.
  • Psychosis (Schizophrenia, hallucinations)
  • Delusions

The most common explanation for malingering is greed, but it is not the only explanation.  

Paranoid Personality Disorder* may produce unintentional or non-malicious report of a distortion of events, feelings and emotional reactions.

PPD is the misinterpretation of the intent of others and their behavior. Such a person may believe they are telling the truth as they say it, but their perception itself is distorted.

However, Paranoid Personality Disorder can produce a driving need for validation which can only be resolved by a jury or judge. Such an individual is less likely to accept a settlement in lieu of a final judgment of “exoneration.”

The malingerer who seeks financial gain, on the other hand, will see settlement negotiations differently.

*See Diagnostic and Statistical Manual, 5th Ed.

SUICIDE AND SUICIDOLOGY

If you are thinking about suicide or need help, call the National Suicide Hotline.  

1-800-273-8255

Reach out. There is help for you.

Considerations: Legal Questions

At-risk. What makes a person at-risk to attempt suicide? Dr. Adhia has treated patients at high risk for Suicide or a Suicide attempt throughout his career. Complicating questions he considers, in addition to events that give rise to litigation or criminal behavior, are medications and pre-existing conditions such as Major Depressive Disorder (MDD) or Bipolar Disorder.

High-risk behavior. Russian Roulette is an example of high risk behavior. “Death-defying” acts are high-risk.  This does not mean the individual wants to commit suicide. For example, they  may have an Impulse Disorder.

Self-harm behavior, like “cutting,” or other non-suicidal self injury (NSSI) can be confused with a suicide attempt. A forensic IME is necessary to make the right diagnosis. Self-harm is not always associated with suicidal intent, supported by clinical evidence and Dr. Adhia’s experience.

What is Suicidology?

Suicidology is a field of study about suicide. It addresses the nature of suicide and people who are at greatest risk for attempting suicide.  In litigation, someone who has attempted suicide may believe it is the result, or fault, of another’s actions and claim for recompense. When a person commits suicide, family members may sue for wrongful death.

Evaluating if a Mood Disorder exists is one piece of the Forensic Psychiatrist’s job in such cases. Certain mood disorders have been found to increase the risk for suicide attempts. Many people believe suicide is always and only associated with severe Depression.  This incorrect.

An attempted suicide is sometimes a “cry for help.” It may be a response to overwhelming grief and/or severe depression, for example.  That does not mean it is in the inevitable outcome of circumstances giving rise to litigation.

Dr. Adhia assesses individuals who have attempted suicide. He may request an Independent Medical Examination.  On the other hand, where there is a completed suicide (death), records, history and observations are essential.  

Dr. Adhia notes that in a wrongful death lawsuit, if the cause of death is unclear and the circumstances suggest possible suicide, he is qualified, as a licensed physician, to review an autopsy report and other records to come to forensic conclusions about a person who is no longer alive to tell their own story.

SEVERE MENTAL ILLNESS