Transcript View slides - AMSUS Continuing Education

COL (Ret) Elspeth Cameron Ritchie
MD, MPH
Presenter has no interest to disclose.
PESG and AMSUS staff have no interest to disclose.
This continuing education activity is managed and
accredited by Professional Education Services Group
in cooperation with AMSUS. PESG, AMSUS, and all
accrediting organization do not support or endorse
any product or service mentioned in this activity.
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Know the DSM-5 definition of PTSD.
Know how PTSD may be used in the courtroom.
Understand how mefloquine may affect criminal
behavior.
 Traumatic experience leads to:
Threat of death/serious injury
• Intense fear, helplessness or horror
•
 Symptoms (3 main types)
Reexperiencing the trauma (flashbacks, intrusive thoughts)
• Numbing & avoidance (social isolation)
• Physiologic arousal (“fight or flight”)
•
 Which may cause impairment in
•
Social or occupational functioning
 Persistence of symptoms
mTBI may be associated with PTSD, especially in the context of
Blast or other weapons injury
Slide 4
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Removes Criterion A-2
Additional criteria
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Slide 5
Somatic reactions
Sleep
Depressive symptoms
Anger and irritability
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Insanity
Diminished Capacity
Coerced/False Confessions
Mitigation
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As a result of severe mental disease or defect, the
defendant was unable to appreciate the nature and
quality or wrongfulness of his conduct
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Severe mental disease or defect or intoxication
prevented the defendant from forming the
requisite mens rea for the charged offense
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The circumstances and nature of the interrogation
and the defendant’s psychological vulnerabilities
may have interfered with the voluntariness and/or
truthfulness of statement.
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The defendant’s PTSD may not have rendered him
insane or negated the culpable mens rea, but it still
may have impacted upon his actions such that it
should be taken into account at sentencing.
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Central theme is that symptoms mislead the
defendant into reading a greater degree of threat
into a given situation and overreacting in response.
Dissociative flashbacks
 Irritability
 Hypervigilance
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Flashbacks may interfere with reality testing which
would interfere with appreciation of the nature and
quality and wrongfulness of the defendant’s
conduct, thus rendering him insane at the time of
the alleged offense.
A defendant in a flashback may misperceive the
degree of threat in a given situation and may lead
him to erroneously believe that he must act
violently in self-defense.
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Irritability may impair a defendant’s ability to
control his behavior and to act more violently than
is warranted by the situation
May negate mens rea or be mitigating
Roxanne Laboratories. Mefloquine Hydrochloride. United States Product Insert. June, 2013.
Roxanne Laboratories. Mefloquine Hydrochloride. United States Product Insert. June, 2013.
Ringqvist Å, Bech P, Glenthøj B, Petersen E: Acute and long-term psychiatric side effects of mefloquine: A Follow-up on Danish
adverse event reports. Travel Med. 2015;13(1):80-88.
“…It is also important to point
out that the mefloquineinduced brain stem injury
revealed by silver staining is
permanent in nature….”
Dow G et al. Mefloquine induces dose-related neurological effects in a rat model. Antimicrob Agents Chemother. 2006
Mar;50(3):1045-53.
Chronic Toxidrome
Severity
Prodrome
Acute/Subacute
Intoxication
Time
Vivid Dreams, Malaise
Sleep Disturbance,
Nightmares, Personality
Change, Disinhibition,
“Anxiety,
Depression, Restlessness or
Confusion”, Mania,
Psychosis, Disorientation,
Amnesia, Neurological
Symptoms
Chronic
Neurological
Symptoms,
Behavioral, Mood,
and Cognitive
Changes
Ritchie EC, Block J, Nevin RL. Psychiatric Side Effects of Mefloquine: Applications to Forensic Psychiatry. Journal of the American
Academy of Psychiatry and the Law. 2013;41(2):224-235; Nevin RL. Mefloquine and Posttraumatic Stress Disorder. In: Ritchie EC,
ed. Textbook of Military Medicine. Forensic and Ethical Issues in Military Behavioral Health. Washington, DC: Borden Institute;
2015.
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