What I Learned Part II

Psychiatry residents on the APA listserv were surveyed about their experiences with social media. 9.7% of residents had gotten friend requests from patients. The remaining residents were asked what they would do if they got such requests. 85% of residents said they would automatically ignore them. 15% said they would discuss the request with the patient, then decline it. Less than 3% of residents received any training about proper social media use in residency. Half admitted googling their patients.

One poster presented the results of a one year study of four major media outlets: the New York Times, the LA Times, USA Today and Fox News. The outlets were culled for articles related to mental illness and violence. The stories were scored according to how many contained one of the follow true facts about mental illness and violence:
1. The majority of mentally ill are never violent.
2. People with mental illnesses are more likely to be victims of violence than perpetrators
3. People with mental illnesses are more likely to be violent against themselves than against others
4. When violent, they are more likely to victimize family than strangers.
Fewer than five percent of the articles contained any of these facts.

The state of New York has successfully used electronic monitoring and regular clinician feedback to reduce the use of polypharmacy in the state prison system.

All state prison systems were surveyed regarding their policies regarding pornography. Of 43 responding states, all banned material that represented a risk to institutional safety and security. There was high variability regarding allowed visual or verbal depictions of sexual acts. There is no published data to support any policy link between prison safety and the presence of pornography.

Crisis intervention training for police is thought to be helpful to reduce incidents of violent outcomes when responding to acutely mentally ill people, but the content of the training varies between program and lacks consistency. There also needs to be more outcome studies to learn if these programs do actually divert mentally ill people out of the criminal justice system.

The PCL-R is coming under pressure as a risk prediction tool. There was a great pro-con debate about this presented by a panel of Broadmoor Hospital psychiatrists. Although interrater reliability is 0.8, there is still significant variance in scores and this could be enough to cause inconsistency when using cutoff scores to determine readiness for release from their severe personality disorder program. It stood out as a risk prediction tool in the 1990's because it was the only one of its kind, but newer tools are being developed with better ROC-AUC scores.

Lastly, multiple personality disorder is coming back. In spite of recent books such as Sybil Exposed, Creating Hysteria and I'm Eve, which document the role the therapist played in the creation or course of the disorder, one presentation today still featured a criminal defendant thought to suffer from multiple personality disorder. This presentation would have been much more effective had there been another expert presenting the potential pitfalls of examining criminal defendants for this disorder. The psychiatrist in this presentation fell into many of those pits: he presented a videotape of the interview in which he asked probing and leading questions (admitting at one point he had to "dig" for symptoms for 20 minutes before the defendant reported any!), and occasionally referring to the defendant as a "patient" rather than as a defendant---clear evidence of bias. The redeeming feature of the presentation was an overview of case law regarding competency and insanity and MPD.

In 2006 there were 4000 civilly committed sex offenders in the US. In this panel they took maps of several large cities in New York, overlaid a map of schools and school bus stations, then overlaid a map of available housing. Finally, the last overlay was a map of legal exclusion zones---boundaries of areas that were legally "off-limits" to convicted sex offenders. This illustrated, at least in Buffalo, New York, that there was literally no place for a sex offender to legally live within city limits. Then they overlaid a map of reported home addresses of sex offenders: 90% were living in restricted areas. There is increasing evidence to suggest that sex offender registration and living restrictions may increase recidivism.

So that's the second conference day. I also enjoyed the computer committee's presentation, which was a two hour geek-fest off all things tech and forensic. It's something you just have to witness to appreciate, sorry. Lots of cloud-based software for document management and report-writing. Not relevant to most Shrink Rap readers but fun for me.

Now I Remember

So in my post from yesterday I talked about the normal process of memory and forgetting. Right after I published that post I started thinking about all the weird little things that I remember.

In order to be a doctor you have to have a pretty good memory. You start out by memorizing muscles and bones and nerves and blood vessels, and work your way into the body by memorizing types of cells and cell processes and biochemical reactions. (How many of you remember how many molecules of ATP are produced in the Kreb's cycle?) The comedian who played Father Guido Sarducci on Saturday Night Live used to have this bit where he'd advertise for the Five Minute College. By sending him lots of money and taking his Five Minute College course, you could get a college degree while learning everything a college graduate remembers five minutes after leaving college.

I'm always surprised by the little factoids and trivia I remember, both in day-to-day life and from college days decades ago. I remember my friend's apartment number because it's the same as the year Jamestown was founded. I remember my childhood phone number (OK, that's an easy one---it's two digits repeated two or three times) as well as the addresses for all the apartments I've ever lived in.

Remembering things too well is rarely a problem for people. When it happens it's usually in the context of unpleasant or horrible memories, memories that intrude on day-to-day life and are upsetting or interfere with one's ability to function, as in post-traumatic stress disorder. These situations are usually managed with therapy, although now people are also experimenting with the use of medications to prevent the formation of intrusive memories after traumatic events. This is still too experimental to be practically useful, however.

Of course, we know that memory is not always a reliable thing. We remember childhood events differently than our older siblings, or not at all. In the 1980's following years of a movement for the treatment of trauma survivors we learned both that bad memories can be repressed, but also they can be created through false memory syndrome. The amazing thing is that false memories can be just as convincing to the individual as real ones.

Speaking of false memory syndrome, here's a practical example. When I started writing this post I was feeling rather pleased with myself that I remembered how many ATP's were produced by the Kreb's cycle. I was wrong. See if your memory is better than mine by checking out this link here.