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Psychiatric illness may also render a per- son unfit for interview by virtue of its effect on cognitive processes or because of associated thought disorder (80 buy genuine accutane on line scin care,81) order accutane 30mg otc acne scar treatment. However, careful questioning that avoids the use of leading questions and coercive pressures can often elicit reliable testimony. That a suspect suffers from an illness, such as schizophrenia, does not necessarily mean that he or she is unfit for interview (82); such an opinion would depend on the likely demand characteristics of the interview and the functional assessment by the doctor. Learning Difficulties The police rarely have difficulty recognizing moderate or severe learn- ing difficulties, but borderline or low-to-normal intelligence may not be obvi- ous even to trained observers (83–85). It is important to identify people with learning difficulties—questions regarding reading and writing ability and the need for special help with education can be useful—because they will be par- ticularly vulnerable in police custody. Such individuals may have difficulties in understanding their legal rights and in communicating with police officers. The Effect of Physical Illnesses on Fitness for Interview The presence of any physical illness renders an individual more vulner- able when faced with a stressful situation, such as a custodial interrogation. Features, such as anxiety or depression, affect a person’s ability to function during the police interview, and physical illness—especially if severe—is as likely to cause anxiety and depression as any other form of stress (87). The severity of the emotional response will depend on the nature of the illness itself, the personality of the individual, and social circumstances. Suspects who are already coping with physical illness are more likely to focus on the short-term consequences of their behavior than the long-term outcomes, thus increasing the risk that they might provide a false confession (52). Because the effect of physical illness on a person’s coping strategy is not disease-specific, depending more on the actual or perceived severity of the ill- ness rather than the nature of the illness itself, the actual diagnosis is unimpor- tant. By contrast, there are many physical illnesses in which characteristic disturbances in cognitive functioning have been recognized (88). With these illnesses, the nature and degree of the mental disturbance produced depends entirely on the diagnosis of the underlying condition. The more common of the conditions encountered in custody are discussed in the following subheadings. Epilepsy It is now clear, after long historical dispute, that a predisposition to epileptic fits does not mean per se that there will be associated intellectual impairment, personality disorder, or mental illness. Most patients with epi- lepsy remain mentally normal, although this does depend on the presence, site, and extent of any brain damage underlying the epilepsy (89). However, those patients with epilepsy without significant brain damage do, nonetheless, remain prone to cognitive impairment, particularly memory impairment, as a result of their epilepsy and its treatment. The potential impact of this cognitive impairment must be considered when assessing a patient with epilepsy’s fitness for interview. For example, problems with concentration, memory, and intellectual func- tioning can be seen when anticonvulsant drugs are administered in toxic doses or unsuitable combinations (90). Suspicion should be raised when a suspect complains of mental lethargy or appears to be performing below expected levels, symptoms particularly associated with toxicity.

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A tomograph is a radiographic presentation Forensic dental radiography 197 of a thin slice of tissue selected from within the object being imaged generic accutane 40mg line skin care brands. Te three planes are also linked to each other so that any entity within the object may be observed from three diferent views in an interactive manner discount 30mg accutane fast delivery skin care 99. Te beam is instead three- dimensional and produces three hundred or more full-size images of the selected tissue feld from 360° of rotation about the patient. Where a pixel is a lateral and vertical image unit, the voxel is in the shape of a cube (e. At least two machines currently available scan the subject in the supine position, which makes them suitable as morgue and mass disaster equipment. Any intraoral or extraoral flm image view can be reconstructed from one scan, with the operator having the ability to select any desired slice location and orientation. Tus, it is possible to plot a plane within the confnes of the dental arches and produce a panoramic image without the overlying ghost images and artifacts of conventional panoramic radiography. Te thickness of the panoramic image layer may also be deter- mined in an unlimited manner. Also, computer algorithms correct for the geometric distortions that are present within all plane flm images. Also, a single scan of the victim can later be compared to any possible variety of submitted ante- mortem plane flm images (i. Tis establishes the orientation of the flm series as if the viewer is facing the patient. However, a very common concern in forensic dentistry is the orien- tation of duplicate antemortem radiographs where the dimple of the original flm can be seen but not felt. Te most reliable method of determining if the dimple was up at the time of duplication is to consider the location of the bump relative to the corners of the individual flms themselves. Whenever the dimple is placed upward or out on a flm, its location will always be in the lower right or upper lef corner of the flm when it is oriented horizontally (Figure 10. Te letters stamped on the flm read correctly when the dimple is up or out when viewed on the view box. Tat is, the beam should enter from the buccal or facial with the flm placed to the lingual. Should this not be taken into account, the flm-orienting dimple will be positioned incorrectly and the teeth will appear to be from the opposite side of the arch and will be misidentifed. Tat is, the beam is always directed upward and from lingual toward buccal or facial.

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These include the following: • Child abuse or neglect • Parental rejection or abandonment • Harsh or inconsistent discipline • Emotional deprivation • Parental substance abuse • Parental unpredictability Symptomatology (Subjective and Objective Data) 1 order accutane with mastercard acne xlr. Increasing tension before committing the theft 20mg accutane amex acne attack, followed by pleasure or relief during and following the act 6. The need to gamble or loss of money interferes with social and occupational functioning 11. Increasing tension followed by a sense of release or gratifica- tion from pulling out the hair 15. Impulse Control Disorders ● 259 Related/Risk Factors (“related to”) [Possible familial tendency] [Dysfunctional family system, resulting in behaviors such as the following: Child abuse or neglect Parental rejection or abandonment Harsh or inconsistent discipline Emotional deprivation Parental substance abuse Parental unpredictability] Body language (e. Long-term Goal Client will not harm others or the property of others (time dimension to be individually determined). Be honest, keep all promises, and con- vey the message that it is not the person but the behavior that is unacceptable. Maintain low level of stimuli in client’s environment (low lighting, few people, simple decor, low noise level). A stimu- lating environment may increase agitation and promote aggressive behavior. Make the client’s environment as safe as possible by removing all potentially dangerous objects. Because of weak ego development, client may be unable to use ego defense mechanisms correctly. Helping him or her recognize this in a nonthreatening manner may help reveal unresolved issues so that they may be confronted. Help client recognize the signs that tension is increasing and ways in which violence can be averted. Activities that require physical exertion are helpful in relieving pent-up tension. Explain to the client that should explosive behavior occur, staff will intervene in whatever way is required (e. This conveys to the client evidence of control over the situation and provides a feeling of safety and security. The client is able to verbalize the symptoms of increasing tension and adaptive ways of coping with it. Related/Risk Factors (“related to”) [Central nervous system trauma] [Mental retardation] [Early emotional deprivation] [Parental rejection or abandonment] [Child abuse or neglect] [History of self-mutilative behaviors in response to increasing anxiety: hair-pulling, biting, head-banging, scratching] Goals/Objectives Short-term Goals 1. Client will cooperate with plan of behavior modification in an effort to respond more adaptively to stress (time dimen- sion ongoing). Intervene to protect client when self-mutilative behaviors, such as head-banging or hair-pulling, become evident. A helmet may be used to protect against head-banging, hand mittsto prevent hair-pulling, and appropriate padding to pro- tect extremities from injury during hysterical movements.

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