THE PSYCHOLEGAL IMPLICATIONS OF BRAIN TRAUMA A CASE OF EPISODIC DYSCONTROL AND CENTRAL BRAIN TRAUMA Adam M. Weisman, Ph.D....
Introduction <ul><li>Common forensic examinations </li></ul><ul><ul><li>Domestic violence: relationship-based </li></ul></...
Introduction <ul><li>Overt neurological condition: effective total defense strategy </li></ul><ul><ul><li>E.g., post-concu...
Case of Ms. P. <ul><li>21-year-old, single, employed, African-American female </li></ul><ul><li>Charge: two counts assault...
Background Information <ul><li>Born in Los Angeles County; parents never married; mother in drug rehabilitation, father ki...
Background History <ul><li>Education: high school graduate </li></ul><ul><li>Work: data entry clerk with temporary agencie...
Background History <ul><li>Psychosexual history </li></ul><ul><ul><li>Sexual activity: initiated at age 18 with victim </l...
Medical History <ul><li>Summer of 2004 (age 19) developed severe headaches </li></ul><ul><li>CT scan showed pituitary mass...
Medical History <ul><li>Prolactin level 181 ng/ml in Feb. 2005 </li></ul><ul><li>MRI in March 2005 showed 2 cm pituitary a...
T1-weighted, non-contrast Magnetic Resonance Image
Medical History <ul><li>Treated with dopamine agonist (Dostinex ®  (cabergoline)) </li></ul><ul><li>Over next several mont...
Medical History <ul><li>Underwent transsphenoidal resection of the adenoma in Sept. 2005, just over one month prior to the...
Neuropsychiatric complications common with pituitary tumors <ul><li>Neuropsychiatric manifestations are common in CNS tumo...
Neuropsychiatric complications of tumor resection <ul><li>In some cases, surgical treatment of adenomas can lead to cognit...
Disposition <ul><li>2/4/06: Forensic report for defense </li></ul><ul><li>4/28/06: plead no contest to charges; one count ...
Conclusion <ul><li>Forensic evaluations should always include a thorough medical history </li></ul><ul><li>Pre- and Post-s...
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The Psycholegal Implications of Brain Trauma

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The Psycholegal Implications of Brain Trauma

  1. 1. THE PSYCHOLEGAL IMPLICATIONS OF BRAIN TRAUMA A CASE OF EPISODIC DYSCONTROL AND CENTRAL BRAIN TRAUMA Adam M. Weisman, Ph.D. & Joseph R. Simpson, MD, PhD USC Institute of Psychiatry, Law and Behavioral Science
  2. 2. Introduction <ul><li>Common forensic examinations </li></ul><ul><ul><li>Domestic violence: relationship-based </li></ul></ul><ul><ul><li>Episodic dyscontrol: unprovoked & odd </li></ul></ul><ul><li>Common psycho-legal issues </li></ul><ul><ul><li>Diagnostic considerations: linked to causation </li></ul></ul><ul><ul><ul><li>Static variables: constitutional traits </li></ul></ul></ul><ul><ul><ul><li>Dynamic variables: situational (e.g., medical) </li></ul></ul></ul><ul><ul><li>Risk of danger to victim/community </li></ul></ul><ul><ul><li>Dispositional recommendations </li></ul></ul>
  3. 3. Introduction <ul><li>Overt neurological condition: effective total defense strategy </li></ul><ul><ul><li>E.g., post-concussion, post-stroke, seizures, dementia </li></ul></ul><ul><li>Covert neurological condition: difficult to use for complete defense in violence </li></ul><ul><ul><li>Appears normal apart from nonspecific symptoms (nausea, headaches or dizziness) </li></ul></ul><ul><ul><li>Mitigation strategy (charge or sentence reduction) </li></ul></ul><ul><li>Case presentation: covert neurological condition presented as defense for violent act </li></ul>
  4. 4. Case of Ms. P. <ul><li>21-year-old, single, employed, African-American female </li></ul><ul><li>Charge: two counts assault with deadly weapon (knife) </li></ul><ul><li>Victims: ex-boyfriend & ex-boyfriend’s girlfriend </li></ul><ul><li>10/26/05: offense date </li></ul>
  5. 5. Background Information <ul><li>Born in Los Angeles County; parents never married; mother in drug rehabilitation, father killed 1992 from hit-and-run vehicle accident </li></ul><ul><li>2 nd child with 1 brother, 2 sisters, 5 paternal half brothers & 6 paternal half sisters </li></ul><ul><ul><li>Criminal history: mother-commercial burglary, sister-check fraud </li></ul></ul><ul><ul><li>Substance use history: parents-cocaine </li></ul></ul><ul><ul><li>Mental illness history: sister-bipolar illness </li></ul></ul><ul><ul><li>Abuse/neglect: raised by aunt due to mother’s substance use; molestation by adult preteen years without report </li></ul></ul>
  6. 6. Background History <ul><li>Education: high school graduate </li></ul><ul><li>Work: data entry clerk with temporary agencies </li></ul><ul><li>Substance use history: casual alcohol use </li></ul><ul><li>Criminal history: none </li></ul><ul><li>Psychiatric history: none </li></ul>
  7. 7. Background History <ul><li>Psychosexual history </li></ul><ul><ul><li>Sexual activity: initiated at age 18 with victim </li></ul></ul><ul><ul><ul><li>Victim: Jamaican alien, 37, married </li></ul></ul></ul><ul><ul><ul><li>Relationship: 2.75 years </li></ul></ul></ul><ul><ul><ul><li>Defendant and victim’s spouse aware of extramarital relationship </li></ul></ul></ul><ul><ul><ul><li>Defendant unaware of intimacy between boyfriend and victim #2 </li></ul></ul></ul><ul><ul><ul><li>Drastic change in relationship: 9/23/05 </li></ul></ul></ul>
  8. 8. Medical History <ul><li>Summer of 2004 (age 19) developed severe headaches </li></ul><ul><li>CT scan showed pituitary mass </li></ul><ul><li>Headaches resolved, no follow-up for several months </li></ul><ul><li>In early 2005 headaches returned and she developed galactorrhea </li></ul>
  9. 9. Medical History <ul><li>Prolactin level 181 ng/ml in Feb. 2005 </li></ul><ul><li>MRI in March 2005 showed 2 cm pituitary adenoma with hemorrhage </li></ul>
  10. 10. T1-weighted, non-contrast Magnetic Resonance Image
  11. 11. Medical History <ul><li>Treated with dopamine agonist (Dostinex ® (cabergoline)) </li></ul><ul><li>Over next several months adenoma shrunk by roughly half as seen on repeat MRI in late August 2005 </li></ul><ul><ul><li>Prolactin level had also normalized </li></ul></ul><ul><li>She elected surgery to remove the adenoma </li></ul>
  12. 12. Medical History <ul><li>Underwent transsphenoidal resection of the adenoma in Sept. 2005, just over one month prior to the instant offense </li></ul>
  13. 13. Neuropsychiatric complications common with pituitary tumors <ul><li>Neuropsychiatric manifestations are common in CNS tumors. </li></ul><ul><li>Behavioral symptomatology reported in as much as 60% of cases of pituitary tumors. </li></ul><ul><li>Disturbances include mood, anxiety and psychotic symptoms and cognitive impairment. </li></ul><ul><ul><li>Price TRP. Neuropsychiatric Aspects of Brain Tumors. In: Sadock BJ and Sadock VA eds. Kaplan and Sadock’s Comprehensive Textbook of Psychiatry , 8 th ed. Philadelphia: Lippincott Williams and Wilkins; 2005: 361-377 </li></ul></ul><ul><ul><li>Wilcox JA, Naranjo J. Psychiatric manifestations of pituitary tumors. Psychosomatics . 1997 Jul-Aug;38(4):396-7. </li></ul></ul>
  14. 14. Neuropsychiatric complications of tumor resection <ul><li>In some cases, surgical treatment of adenomas can lead to cognitive or psychiatric sequelae. </li></ul><ul><ul><li>Guinan EM, Lowy C, Stanhope N, Lewis PD, Kopelman MD. Cognitive effects of pituitary tumours and their treatments: two case studies and an investigation of 90 patients. Journal of Neurology & Neurosurgurical Psychiatry . 1998 Dec;65(6):870-6. </li></ul></ul><ul><ul><li>Peace KA, Orme SM, Padayatty SJ, Godfrey HP, Belchetz PE. Cognitive dysfunction in patients with pituitary tumour who have been treated with transfrontal or transsphenoidal surgery or medication. Clinical Endocrinology (Oxford). 1998 Sep;49(3):391-6. </li></ul></ul>
  15. 15. Disposition <ul><li>2/4/06: Forensic report for defense </li></ul><ul><li>4/28/06: plead no contest to charges; one count dismissed </li></ul><ul><li>Suspended sentence on formal probation; 180 days credit time; $998 restitution to victim #2 </li></ul><ul><li>Approximately 15 months after the instant offense </li></ul><ul><ul><li>No further episodes of aggression or impulsivity; resumed temporary clerical duties </li></ul></ul><ul><ul><li>No clear evidence of neuropsychiatric dysfunction on clinical interview or neuropsychological screening tests </li></ul></ul>
  16. 16. Conclusion <ul><li>Forensic evaluations should always include a thorough medical history </li></ul><ul><li>Pre- and Post-surgery involving CNS system may influence the management of prosocial behavior </li></ul><ul><li>Presentation of hypotheses involving covert neurological condition may influence legal parties in terms of mitigation </li></ul>

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