Psychiatric Diagnoses on the Stand A DSM Primer

Transcription

1 Psychiatric Diagnoses on the Stand A DSM Primer John A. Zervopoulos, Ph.D., J.D., ABPP PsychologyLaw Partners Dallas Bar Assn. Family Law Section May 11, 2011

2 John A. Zervopoulos, Ph.D., J.D., ABPP PSYCHOLOGYLAW PARTNERS A Forensic Consulting Service Harvest Hill Road, Suite 210, Dallas, Texas jzerv@psychologylawpartners.com Telephone: EDUCATION J.D., Southern Methodist University Dedman School of Law (1993). Ph.D. in Psychology, University of North Texas (1981). Board Certified in Forensic Psychology by the American Board of Professional Psychology (2002). B.A. in Psychology, Wheaton College (IL) (1974). PROFESSIONAL ACTIVITIES Director, PSYCHOLOGYLAW PARTNERS A forensic consulting service that works with lawyers to organize, critique, and use psychological materials and evidence effectively from both the psychological and legal perspectives. Member, American Psychological Assn. Committee on Professional Practice and Standards (COPPS) Reviews and drafts APA professional practice guidelines. RECENT SELECTED PUBLICATIONS AND PRESENTATIONS CONFRONTING MENTAL HEALTH EVIDENCE: A PRACTICAL GUIDE TO RELIABILITY AND EXPERTS IN FAMILY LAW (book published in 2008 by the ABA). PsychologyLaw Brief a free semi-monthly of legal practice tips related to psychological expert testimony. Subscribe at Monthly column on experts and mental health testimony published in the Collin Co. Bar Assn. BarTabs; Dallas Bar Assn. Fam. Law Section Newsletter; and the Denton Co. Bar Assn. Denton Lawyer. Quarterly column published in the TX State Bar Fam. Law Section Report. Daniel W. Shuman & John A. Zervopoulos, Empathy or Objectivity: The Forensic Examiner s Dilemma? 28 Behavioral Sciences & the Law 585 (2010). John A. Zervopoulos, Drafting the Parenting Evaluation Court Order: A Conceptual and Practical Approach. 28 Behavioral Sciences & the Law 480 (2010). Conflicting Court-Appointed MH Expert Roles. Presented with paper at the 2009 Adv. Fam. Law Course, State Bar of Texas (with Angeline L. Bain, Hon. Scott A. Beauchamp, and Julia Z. Kaufman; August 2009). Confronting Mental Health Evidence. Presented to the 22nd Neglect & Delinquency Practice Institute. The Bar Assn. of the District of Columbia, Washington, D.C. (March 2010); also presented to the Michigan Judicial Child Welfare Symposium (June 2009). How Do You Know? Separating Wheat From Chaff in Mental Health Testimony. Presented to Wisconsin Inter-Professional Committee on Divorce (May 2009).

3 DSM-IV-TR Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision What is a Mental Disorder? A clinically significant behavioral or psychological syndrome or pattern that occurs in a person. It requires that there be clinically significant impairment or distress in social, occupational, or other important areas of functioning. Four Keys Be aware of 2 important DSM forensic principles. Understand DSM s development + structure. Identify some DSM-IV concerns. Recognize the critical use of Judgment in DSM-IV diagnoses. 1

4 Two Important Principles Labeling someone with a diagnosis is a clinical issue. Whether that diagnosis should serve as a legal determinant for competence, compensation, or commitment is a legal issue. DSM-IV: Different Impact in Different Cases Insanity Defense; Civil Commitment; Personal Injury Litigation; Child Custody; Testamentary or Contractual Competence Determinations. DSM Purposes Communicate among MH clinicians, researchers, and educators; Plan MH treatment and anticipate treatment outcomes. Reimbursement guide for the health care/ insurance industry. 2

5 DSM Development DSM-I (1952): More than a listing of diagnostic labels. DSM-II (1968): More developed than DSM-I, but comparable approach. DSM Development DSM-III (1980) Watershed - Grew from 1970s psychiatric research. - Relied more on research-based signs, symptoms, and specific diagnostic criteria. - Introduced Axis approach to organizing and reporting mental disorders. - DSM-III-R (1987) revised some DSM-III content. DSM Development DSM-IV (1994) - Continued DSM-III s empirical/research emphasis. - Included more diverse group of MHPs in work groups. - Introduced fourth and fifth axes to organizing and reporting mental disorders. - DSM-IV-TR (2000) updated research support for several diagnoses. 3

6 DSM-IV s Diagnosis Structure Axis I: "Clinical Disorders Axis II: "Personality Disorders " Axis III:"General Medical Conditions Axis IV: "Psychosocial and Environmental " " "Problems Axis V: "Global Assmt of Functioning Some DSM Concerns Some diagnoses are still based more on compromise of interests and professional consensus rather than on empirical evidence. Subjective-oriented symptoms. Classification issues. PTSD: Criteria B - F Criterion B: Persistent reexperiencing of traumatic event. Criterion C: Persistent avoidance of stimuli associated with the trauma. Criterion D: Persistent symptoms of arousal. Criterion E: Symptom duration more than one month. Criterion F: Disturbance causes clinically significant distress or impairment. 4

7 DSM-II and the Courtroom Anticipated its use in consultation to the courts. (DSM-II at viii) DSM-III-R and the Courtroom The clinical and scientific considerations involved in categorization of these conditions as mental disorders may not be wholly relevant to legal judgments, for example, that take into account such issues as individual responsibility, disability determination, and competency. (DSM-III- R at xxiv) DSM-IV and the Courtroom For forensic purposes, there are significant risks that diagnostic information will be misused or misunderstood. These dangers arise because of the imperfect fit between the questions of ultimate concern to the law and the information contained in a clinical diagnosis. (DSM-IV-TR at xxxii) 5

8 DSM and Clinical Judgment The criteria are meant to serve as guidelines to be informed by clinical judgment. Criteria are not meant to be used in cookbook fashion or to be applied mechanically by untrained individuals. (DSM- IV-TR at xxxii) DSM and Clinical Judgment DSM-IV criteria reflect prototypical case. Patients with same diagnosis may differ. Diagnostic boundaries may be fuzzy. DSM-IV offers some diagnostic latitude for less clearly defined cases. Clinical Judgment Balance If clinicians do not exercise clinical judgment, they will be slavishly following a system with admittedly and necessarily arbitrary boundaries. On the other hand, the excessively flexible and idiosyncratic application of the system (or ignorance of it) substantially reduces its utility as a common language for communication among clinicians and across the research-clinical interface. (DSM-IV Guidebook 68). 6

9 NOW AVAILABLE... Confronting Mental Health Evidence A Practical Guide to Reliability and Experts in Family Law By John A. Zervopoulos, Ph.D., J.D., ABPP How do you know what you say you know? This is the key question the family lawyer should ask when evaluating the reports and testimony of mental health professionals, their methods, and the materials that support their conclusions and expert opinions. In Confronting Mental Health Evidence, Dr. John A. Zervopoulos presents a practical, case-based model that will empower lawyers to manage difficult psychology-related issues that attend their cases and to hold mental health experts accountable in court. The first part of the book focuses on the critical emotional, legal, and psychological perspectives that lawyers must understand to manage and use mental health materials and testimony in their cases. The emotional perspective focuses on divorce dynamics that may help or hinder a case's resolution. The legal perspective develops the Frye-Daubert Analysis Model, a practical, case-based model by which lawyers may critique mental health materials, develop their expert examinations, and organize their evidentiary arguments to the court. The psychological perspective, using the Frye-Daubert Analysis Model as a framework, addresses experts conclusions and the means and methods by which experts reach those conclusions and resulting opinions. In Part Two, the author assists lawyers in the most challenging of the Frye-Daubert tasks: exposing analytical gaps in the empirical and logical reasoning that tie experts' methods and data to their opinions. This issue is critical because courts are charged to view opinions with analytical gaps that are too wide as unreliable, and therefore, inadmissible. Finally, Part Three discusses the interplay of patient confidentiality, HIPAA privacy laws, and the psychotherapist-patient privilege when lawyers seek to obtain mental health records. August 2008, 218 pages, 6 x 9, paper, ISBN: Published by the ABA Section of Family Law. Chapter 1 Table of Contents Introduction and Overview PART I. Three Critical Perspectives Chapter 2 The Emotional Perspective Chapter 3 The Legal Perspective Chapter 4 The Psychological Perspective PART II. Exposing the Analytical Gaps: Applying a Scientific-Critical Thinking Mindset Chapter 5 Scientific Critical Thinking Chapter 6 Exposing the Analytical Gaps Chapter 7 Exposing Misapplied or Misrepresented Research: The Example of Domestic Violence Chapter 8 Exposing Confirmatory Bias: The Example of Sexual Abuse Allegations PART III. Obtaining Mental Health Records Chapter 9 Negotiating the Mental Health Records Maze YES! I want to order copy (ies) of Confronting Mental Health Evidence (PC: ) at the special meeting price of $54.95 per copy*. (Regular price is $89.95.) $ Subtotal Payment: $ Tax (DC-5.75%; IL-10.25%) Check enclosed payable to ABA $ Shipping/Handling (up $49.99 add $5.95; $50 - $99.99 add $7.95; VISA MasterCard $100 -$ add $9.95; over $200 add $12.95) American Express $ TOTAL Acct.# Exp. Date Signature Name: Firm/Org: Address: Mail to: Amelia Stone, ABA 321 N. Clark St. City, State & Zip: Chicago, IL Phone: SOURCE: AUTH09 Phone: Fax: Web Site: stonea@staff.abanet.org *Special meeting price valid through 5/31/11 only. Prices subject to change without notice. Thank you for your order.