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Is hiking revelation ( 1914 trio with on great finance make assumed he was lying about his symptoms. When a physician finally ordered hospitalization and MRI, a perispinal abscess had already caused permanent lower extremity paralysis. The case eventually led to a civil damage award of $1 million; one wonders why it was not far more. It happens to psychiatrists and psychologists, too, of course. We all dread missing things like tumors and treatable pseudodementias. Sometimes a general medical referral is sufficient, but we shouldn't always assume that a screening consultation rules out organic illness. We should be especially careful if a patient's psychosomatic condition doesn't improve, or gets worse. One of early forensic cases illustrates the point: A woman complained of difficulty walking just after having a baby. She had no other symptoms, and no indication of infection. A neurological exam was said to be negative, and the obstetrician believed the problem was psychosomatic. He referred her to a psychiatrist, who admitted her to the hospital's psychiatric unit. Over several days, her leg weakness seemed to get worse, and she said she couldn't walk at all, but no additional neurological or other medical consultations were ordered at the time. The psychiatrist took a behavioral approach to the problem, ordering the nursing staff not to help her or allow her to use a wheelchair. She was forced to crawl to meals and the bathroom, on the theory that she would tire of the inconvenience and begin to improve. After several more days without improvement, the psychiatrist ordered another neurological consultation. Testing revealed a large perispinal abscess. Unfortunately, her paralysis had become permanent; diagnosed earlier, she would probably have recovered fully. Consider consultation. If the problem persists, consider doing it again. As friend Dr. Gutheil often says about seeking help, Never worry alone. and Forensic Psychiatry Dr. Wortzel of the University of Colorado Medical Center has taken over spot as forensic contributing editor of the this, his first article, he discusses some challenges of transition to the recently published system, could give rise to increased cynicism courts and renewed skepticism about mental diagnoses and the forensic psychiatrists who testify about them. Opposing lawyers criticize expert witnesses who stick with diagnoses and procedures as out of touch, but also criticize those who immediately adopt the new diagnostic procedures as lacking experience with unproved 5 system. Dr. who chaired the APA task force years ago, has cautioned that even modest changes the evolving clinical nomenclature can have unintended consequences. He refers particularly to what he described as three false positive 'epidemics' to which contributed ADHD, autistic disorder, and childhood bipolar disorders and for which apparent over-diagnosis has caused clinical, financial, and forensic consternation Dr. Wortzel notes that forensic settings are even more prone to unintended consequences and misuse of the than clinical ones, since forensic users and audiences lack the clinical training, purposes, and attitudes contemplated by the APA task force. Experts and other forensic practitioners, should remember that most of the forensic issues which we become involved hinge on psychiatric symptoms and mental not diagnosis. Criminal responsibility, competence to stand trial or do other things, capacities suicide risk, and emotional damage, for example, rest far more on individual function and behavior than on the labels attached to them. Dr. Wortzel's article is the Suicide by Cop local news recently reported the death of a woman who was brandishing a handgun a downtown area at two the morning. Police were called. She refused to put down the pistol. The police attempted nonlethal intervention She kept pointing the handgun at them and, according to reports, they had to shoot. She apparently never fired the weapon. Local media reported it as a possible suicide by cop. another case, a drove into a police station parking lot and began firing at empty police car. He was severely wounded a literal hail of bullets. After the incident, it became clear that none of the dozens of shots he fired with three weapons was really the direction of officers. He had a history of great respect for law enforcement, and planned for the officer who would kill him to be rewarded as a hero. There was a drum