As the first quarter of the 21^st Century comes to an end, the frenetic pace of technological change shows no signs of slowing. Indeed, where artificial intelligence is concerned, the pace seems to be accelerating, with many consequences that are arguably unforeseeable from our current vantage point. AAPL recognizes the need for periodic changes to meet the changing needs of its membership. One such change, which I am excited to introduce to you here, is this first edition of the new AAPL Examiner. This updated version of a venerable AAPL publication will continue to provide the excellent content everyone is accustomed to from the print and Adobe® PDF versions of the AAPL Newsletter. As in its previous iteration, the Examiner will continue to provide excellent value to the AAPL membership through features such as scholarly forensic psychiatry articles, career guidance from seasoned experts, and reports and updates from allied organizations.

The history of AAPL publications begins with a newsletter created with a manual typewriter and then “photo offset” for distribution to the members at the time of AAPL’s founding in 1969. This evolved into the original Bulletin of AAPL two years later. Ultimately, the Bulletin became the AAPL Journal, now a quarterly academic powerhouse relied upon as an educational resource by forensic experts in psychiatry, psychology, social work and law around the world. Meanwhile, for close to half a century, since 1976, the version of the Newsletter which saw its final issue with the Winter 2024 edition earlier this year served a dual role as both an educational platform and an internal communication channel about organization business for AAPL members. While some of the internal communication duties will be fulfilled by another new AAPL product, the monthly email Digest to all members, the new Examiner will also continue the dual mission, in an easily accessible format. AAPL Council, the Associate Editors, and I hope that you find it user-friendly, and we welcome your feedback on this new venture.

AAPL Annual Meeting

Cheryl Wills, MD

AAPL’s 55^th Annual Meeting will take place October 24^th-27^th, 2024 in the Sheraton Vancouver Wall Center in Vancouver, BC, Canada. The coastal city is known for its beautiful landscapes, outdoor activities, restaurants, and shopping. Vancouver is committed to lowering its carbon footprint. AAPL also is committed to climate action. This year, AAPL will be using an app-based program instead of a paper one. Attendees will be able to download the program to their smart devices and computers. The expense of the program app will be offset by the savings from reduced printing and shipping fees.

President's Column

Working in Correctional Institutions: A Challenging but Vital Vocation

Charles C. Dike, MD

In January 2024, Oscar Pistorius, also known as the Blade Runner, was released from prison after serving nearly 11 years for the culpable homicide of his girlfriend, Reeva Steenkamp in 2013. He had shot her four times. Most American observers would be shocked to learn that he was initially sentenced to serve only six years in prison, later changed to 13 years after a challenge by the victim’s family among others. The US has the longest average prison sentence for homicide convictions, 40.6 years compared to 6.1 for France (1). Even more startling is that the US incarcerates more people per 100,000 population (664) than Russia (329) or China (121), according to the Prison Policy Initiative (2).

Request for Contributions to a New Examiner Regular Column "Thank You for Being My Mentor"

AAPL members are invited to submit a brief piece (three to four paragraphs) on one of their mentors for publication in the AAPL Examiner, which is published online three times per year.

The first paragraph would be a brief bio-sketch of the mentor, the second and third paragraphs would share important lessons learned that have been key in the contributor’s practice, and the last paragraph would be simply to say thanks. Submissions should be sent to newslettereditor@aapl.org.

Medical Director's Column

Community Forensic Psychiatry and a Focus on Houselessness

Debra A. Pinals, MD

In 2014, I had the privilege to serve as the President of AAPL. One of the activities that looms large as a requirement of that position is the delivery of the Presidential Address at the Annual Meeting. This is something a typical president spends a great deal of time contemplating and researching, until the day the talk is delivered. The year I took the helm was no exception. I was serving in state government as the Massachusetts Department of Mental Health Assistant Commissioner of Forensic Services at that time, and my views of the systems surrounding people with serious mental illness were shifting.

NEW AAPL PRACTICE RESOURCE

Reproductive Psychiatry/ Women’s Mental Health

in Forensic Psychiatry Practice

This practice resource seeks to describe salient issues within reproductive psychiatry (also known as women’s mental health) for the practice of forensic psychiatry. Understanding is critical and can help combat gender bias in such evaluations. Forensic psychiatric evaluations in the criminal realm, including evaluations related to neonaticide, infanticide, filicide, child abuse, and kidnapping by Caesarean, require an understanding of reproductive psychiatry. Download the new practice resource HERE, and view this and other resources at: www.aapl.org/guidelines

REOPENED

Seeking Applications for AAPL Newsletter Editor

The AAPL Newsletter is seeking a new Editor to begin in 2025. Click here to learn more about applying. A cover letter explaining interest and qualifications as well as a CV should be sent to office@aapl.org by Wednesday, July 31.

Many thanks to Joseph Simpson, MD, who has been Editor for 5 years!

Ask the Experts

Neil S. Kaye, MD, DLFAPA; Graham Glancy, MB, ChB, FRC Psych, FRCP; and Ryan C.W. Hall, MD

We will answer questions from members related to practical issues in the real world of forensic psychiatry. Please send questions to nskaye@aol.com. This information is advisory only, for educational purposes. The authors claim no legal expertise and should not be held responsible for any action taken in response to this educational advice. Readers should always consult their attorneys for legal advice.

Q. The material in my latest case is rather traumatizing for me to digest. Can you help?

Award Nominations

Deadline July 1

Red AAPL

For AAPL members who have provided outstanding service to AAPL, e.g., through committee membership.

Golden AAPL For AAPL members over the age of 60 who have made significant contributions to the field of forensic psychiatry.

Seymour Pollack Award

For APA members (who may not be AAPL members), who have made distinguished contributions to the teaching and educational functions of forensic psychiatry.

Amicus Award

For non-AAPL members who have contributed to AAPL.

Best Teacher in Forensic Fellowship Award

For outstanding faculty member in fellowship program.

Award Descriptions

Submit your nominations to Charles Scott, MD at clscott@ucdavis.edu AND Marie Westlake at mwestlake@ssmgt.com.

In the Media

DMT: More Than Just Your Grandmother’s Ayahuasca Brew

Sonia Ann Marie F. Dela Cruz, MD; Ryan C. W. Hall, MD

In this edition of In The Media, we note the US Customs and Border Patrol’s 2023 press announcement about the interception of 61 pounds of the psychedelic N,N-dimethyltryptamine (DMT) in Texas.(1) Psychedelic drugs have been garnering more attention due to their dual role as both drugs of abuse and potential therapeutic or “spiritual” agents.

Committee Perspectives

The Evolution of Pandemic-Influenced Ketamine Internet Prescribing

Daniell S. Sullivan (MD 2025 Candidate); Ryan C.W. Hall, MD

Psychopharmacology Committee

In the past decade, treatment modalities and indications for ketamine, a noncompetitive NMDA antagonist, have shifted from anesthesia to neuromodulation, based on its antidepressant effects. Duman et al. hypothesized that the biochemical mechanisms responsible for ketamine’s antidepressant properties were AMPA receptor and NMDA-related glutaminergic activity promoting BDNF release, with downstream effects on protein expression and signaling pathways that increase neuronal structural connectivity in the prefrontal cortex. (1) Essentially, ketamine’s secondary epigenetic effects generate new neuronal pathways, which may contribute to its therapeutic efficacy in treatment-resistant depression (TRD). (2)

The Challenge to Provide Core Forensics Training in Residency

David Annas, MD, MPH; Katherine Michaelsen, MD, MASc; Amina Ali, MD

Forensic Training of Psychiatry Residents Committee

Psychiatric residents are often uncomfortable with their proficiency in forensic settings and want more training (1, 2), yet forensic education remains a low priority in academic psychiatry. Surveys of residents in Canada and the US indicate low overall comfort with forensic topics and populations (1, 2) and limited understanding of confidentiality and duties to third parties (3). Unlike for every other accredited subspecialty, the US Accreditation Council for Graduate Medical Education (ACGME) does not mandate a specific Full-Time Equivalent (FTE) for forensic psychiatry, and gives only a broad description of what a forensic experience must include.

“Psychological Fingerprints” and Reliable Forensic Psychiatric Assessment of Emotional Distress Damages Claims

Stuart Kleinman, MD

Trauma and Stress Committee

Reliable forensic psychiatric assessment of emotional distress damages claims requires recognition that seeking financial compensation may influence, or distort, how a litigant relates, recalls, and discloses information. An individual may malinger, i.e., intentionally feign the presence or severity of psychiatric difficulties or misrepresent the source of genuine psychiatric difficulties. Using reliable forensic psychiatric assessment methodology is necessary for determining whether such malingering or misrepresentation is present. Opining about an individual’s emotional distress without substantially more than an individual’s representations is generally of limited utility and potentially misleading to the finder of fact.

Geriatric Sexual Offenders: Exposing An Overlooked Population at Risk

Kathryn Baselice, MD; Brad D. Booth, MD

Sexual Offender Committee

You are asked to evaluate a 68-year-old man who was convicted of multiple counts of sexual assault against minor children. The victims are his grandchildren, and the family is bewildered by his actions. He is recently retired and widowed. He has no previous criminal history, nor a history of sexually violent behavior prior to the index offenses. How would you conceptualize his risk of recidivism, and what recommendations could you offer to mitigate that risk?

Fellows' Corner

Navigating The Ethical Maze of Assessing Competency to be Executed

James C. Zinko, MD

When I began my still very young career in forensic psychiatry, I naïvely believed that I had solidly formed my ethical views on most topics. My views were quickly challenged when I learned about the concept of competency to be executed. Having never lived in a jurisdiction with capital punishment, this was not a topic I had paid attention to. I initially believed it was unethical for psychiatrists to perform competency to be executed evaluations, which stemmed from my conviction that any involvement in the death penalty was immoral. However, as I researched the topic, my views began to change.

Special Article

Restoration Delayed: Dismissal of Serious Felony an Extreme Remedy, But Fining the State Appropriate

Lorenzo Capannolo, MD; Steven Zuchowski, MD; Ashley Maestas, DO

In Nevada vs. Gonzalez (1), the Nevada Supreme Court concluded that the Washoe County District Court abused its discretion when it dismissed a charge of sexual assault. Mr. Gonzalez had moved to dismiss due to a delay in competency restoration treatment, during which he remained in jail for 160 days prior to being transferred to a forensic hospital.

Charles C. Dike Scholarship

Charles C. Dike Scholarship Award

Myrline Rose Belzince, MD

Diversity Committee

2023 Awardees, Sanya Virani, MD, MPH (left) and Myrline Rose Belzince, MD (right) with Charles Dike, MD (middle)

2022 Awardees, Reema Dedania, MD, MPH (left) and Viviana Alvarez-Toro, MD (right) with Charles Dike, MD (middle)

The Charles Dike Scholarship Award was proposed by AAPL Past President, William Newman, MD (2019-2020), to honor Charles Dike, FRCPsych, MBChB, MPH for his many years of active service to AAPL, including four years as assistant to the Editor of the AAPL Journal; eight years as Editor of the AAPL Newsletter; six years as Chair of the Ethics committee; Founding Chair of the Forensic Hospital Services Committee; Founding Chair of the Diversity Committee; Program Chair; and service on AAPL Executive Council , as well as on numerous committees and workgroups.

AMA News

American Medical Association 2023 Interim Meeting Highlights

Jennifer Piel, MD, JD, Delegate; Patricia Westmoreland, MD, Alternate Delegate; Sarah Baker, MD, Young Physician Delegate; Kathryn Skimming, MD, Young Physician Delegate

The American Medical Association’s (AMA) House of Delegates (HOD) met in November 2023 in National Harbor, Maryland. A central theme of the meeting was Medicare payment cuts, but a range of other topics were discussed. Summarized here are three resolutions considered by the HOD:

Medically appropriate psychotropic use and long-term care facilities

Reconsideration of physician assisted suicide (PAS) and adoption of the term “medical aid in dying” (MAID)

Improving access to forensic medical evaluations and legal representation for asylum-seekers

The AAPL Newsletter is published by AAPL, One Regency Drive, PO Box 30, Bloomfield, CT 06002. Opinions expressed in bylined articles and columns in the Newsletter are solely those of the authors and do not necessarily represent the official position of AAPL or Newsletter editors. Manuscripts are invited for publication in the Newsletter. They should be submitted

to the editor via email to NewsletterEditor@aapl.org. The Newsletter is published in Winter (deadline for submission is November 15), Spring (deadline March 1), and Fall (deadline July 1).