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Involuntary commitment (IC) for the treatment of substance use disorders is a highly controversial and poorly understood practice, with California offering a striking example. The state's involuntary commitment laws, known collectively as Lanterman-Petris-Short, authorized IC for grave disability related to chronic alcoholism. These provisions remain shrouded in obscurity, and data on their usage are lacking. Amid the ongoing debate over the utility of IC as a tool to treat severe substance use disorders and legislation expanding IC for substance use disorders (SUDs) in California and other states, this article highlights the need to better study the use and effectiveness of existing legislation as well as to consider upstream interventions, such as expansion of community-based treatment models. [ABSTRACT FROM AUTHOR]

We examined the effects of family functioning and beliefs regarding peers' cannabis use among minority (n 5 112) and non-minority (n 5 275) sexual orientation and gender identity (SOGI), firsttime court-involved adolescents. We examined longitudinally the effects of baseline general family functioning and peer cannabis use beliefs on self-reported cannabis use and cannabis-related consequences after 12 months. At baseline, 39.2 percent of adolescents reported using cannabis. Minority SOGI adolescents reported worse family functioning (p 5 .017) and higher peer cannabis use beliefs (p = .047). Higher peer cannabis use beliefs at baseline predicted recent cannabis use at the 12-month assessment for both minority and non-minority SOGI adolescents. Better family functioning predicted a lower likelihood of recent cannabis use at 12 months for non-minority SOGI adolescents, but not for minority SOGI adolescents. Baseline peer cannabis use beliefs and family functioning predicted cannabis-related consequences for both cohorts at 12 months when accounting for intermediate (i.e., four-month and eight-month) data. Among all first-time court-involved adolescents, those who believed greater cannabis use among their peers reported more subsequent cannabis use themselves. Conversely, higher general family functioning may be less of a protective factor for minority SOGI adolescents. These results suggest the utility of feedback interventions to modify peer norm beliefs among first-time court-involved adolescents. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to examine trends in racial/ethnic and gender representation among US psychiatry residency applicants compared with non-psychiatry applicants. Methods: Using publicly available applicant data, racial/ethnic and gender distributions of psychiatry residency applicants from 2008 to 2019 were examined and compared with non-psychiatry residency applicants. Both longitudinal trends within both cohorts and cross-sectional, between-group differences were examined. Results: From 2008 to 2019, the percentage of female, American Indian/Alaskan Native (AIAN), Black, Hispanic, and Native Hawaiian/Other Pacific Islander (NHPI) psychiatry and non-psychiatry residency applicants increased (p<.001). Within each year, Black and Asian applicants comprised a larger percentage of psychiatry applicants compared with non-psychiatry applicants (p<.001). Between 2008 and 2019, Black psychiatry and non-psychiatry applicants increased from 9.1% to 11.6% and 6.6% to 7.6%, respectively; Asian psychiatry and non-psychiatry applicants decreased from 39.5% to 30.5% and 27.5% to 26.6%, respectively; White psychiatry and non-psychiatry applicants increased from 26.7% to 38.2% and 42.7% to 49.2%, respectively. Conclusions: Racial/ethnic and gender characteristics of US psychiatry residency applicants represent the future of the US psychiatric workforce. The US psychiatry residency applicant pool has become increasingly diverse from 2008 to 2019. Initiatives should work to enhance representation of psychiatry applicants from historically marginalized backgrounds, and simultaneously to recruit and retain a diverse psychiatric workforce following residency training.

Objective: In this study, the authors examined the consistency and the transparency of application instructions for forensic psychiatry fellowships in the USA. Methods: The authors collected the names of US forensic psychiatry fellowships listed in the Directory of Forensic Psychiatry Fellowships maintained by the American Academy of Psychiatry and the Law. Using data from active fellowship websites, the authors extracted for each program: (1) timelines for applications and interviews, (2) whether an application form was supplied, and (3) the presence of specific application requirements (e.g., curriculum vitae, personal statement, letters of recommendation, residency training director evaluations, writing samples). Results: Among 45 fellowship websites, 31 (68.9%) did not provide specific dates or months when their application cycle opened, nor did they indicate whether they accepted applications on a rolling basis. Fourteen (31.1%) did not have an application form, and 8 (17.8%) did not list application requirements. Among 37 programs that listed specific requirements on their websites, 36 (97.3%) required a curriculum vitae or letters of recommendation, 35 (94.6%) required a personal statement and/or letter of interest, and 27 (73.0%) required writing samples and/or evaluation materials from residency program directors. Conclusions: This study found considerable variations among online application instructions for US forensic psychiatry fellowships. Although many factors shape recruitment into forensic psychiatry fellowships, improving the consistency and the transparency of application instructions might decrease stress related to the application cycle and streamline recruitment into the field.

An editorial discussing the National Commission on Correctional Health Care (NCCHC) defines a formulary as a written list of prescription and nonprescription medications that are ordinarily available to authorized prescribers, including consultants, working for the facility, including drug formularies in correctional settings can disrupt psychiatric care during a patient's transition from the community into a prison or jail.

Over the past two decades in the United States, a dramatic increase in access to the Internet has facilitated an increase in the production, viewing, and distribution of child pornography. In this context, forensic mental health professionals may be called on to estimate the risk of future violence, especially of contact sexual offenses, among individuals charged with online sexual offenses. We summarize demographic and clinical characteristics that differentiate online from contact and "mixed" offenders (those who commit both online and contact offenses), offending histories of these three groups, and the current state of knowledge regarding risk of progression from online-only to contact offending. Multiple studies suggest that online, contact, and mixed offenders demonstrate distinct profiles, and wide variations exist in the offense histories of online-offending groups. Longitudinal studies of individuals charged with online offenses are few in number and are mostly limited to detection of formal charges. Nevertheless, available studies suggest that most individuals who are charged with online offenses and who do not have histories of contact offenses are unlikely to engage in future contact offenses. Within the limitations of the current literature, we suggest guidance for the evaluation and treatment of online offenders. [ABSTRACT FROM AUTHOR]

The article focuses on the lower court's refusal to allow S.M. a defendant against a petition for involuntary commitment. It discussed the case of S.M. in which he intended to commit suicide; consider his outpatient treatment and request of S.M. that the district court dismiss his appointed counsel.

Purpose: Our goal was to examine the association between peer victimization (PV) and suicidal ideation (SI), and the degree to which internal resilience moderates this association.

OBJECTIVES To quantify the incidence of adverse events associated with anesthesia given for research-driven imaging studies and to identify risk factors for those events in pediatric research subjects. DESIGN Retrospective cohort study. SETTING National Institutes of Health Clinical Center. PARTICIPANTS Children and adolescents enrolled in clinical research protocols who required anesthesia for research-related imaging studies from January 2000 to September 2008. INTERVENTION Propofol sedation/anesthesia. MAIN OUTCOME MEASURE The occurrence of respiratory, cardiovascular, and all anesthesia-related adverse events that required intervention while receiving anesthetics for research-driven imaging studies and other noninvasive procedures. RESULTS We identified 607 children who received 1480 propofol anesthetic procedures for imaging studies. Seventy percent of anesthetics were given to subjects with severe diseases and significant disabilities (American Society of Anesthesiologists Physical Status [ASA] III). Anesthesia had a mean (SD) duration of 115 (55) minutes, and in 12.5% of procedures, an airway device was necessary. There were 98 notable respiratory, cardiovascular, and other events in 79 anesthetic procedures, a rate of 534 per 10 000 anesthetic procedures with 1 or more adverse events. There was no long-lasting morbidity or mortality. The ASA classification (odds ratio [OR], 2.92; 95% confidence interval [CI], 1.24-6.88), anesthetic effect duration (OR, 1.46; 95% CI, 1.25-1.70), and presence of airway abnormalities (OR, 4.41; 95% CI, 1.60-12.12) were independently associated with adverse events during anesthetic use. CONCLUSION In our clinical research sample of high-risk children who received sedation/anesthesia by an anesthesiologist, we observed a low incidence of adverse events and no long-term complications. Risk factors for adverse events included higher ASA classification, increasing anesthetic duration, and presence of airway abnormalities.Arch Pediatr Adolesc Med. 2010;164(6):554-560--

A 16-year-old left-handed boy with Tourette syndrome (TS) presented to the outpatient neurology clinic complaining of difficulty focusing and completing tasks resulting in impairment at home, school, and social gatherings. He developed recurrent sniffing and throat clearing at age 6, which waxed and waned over time, and had since experienced repeated movements of the head, face, hands, and legs and gulping vocalizations; a diagnosis of TS was established at age 7. His tics were preceded by a premonitory sensation and were partially suppressible. These symptoms led to discomfort, but not impairment. He struggled with planning and organizational skills since age 6, and at age 12 developed repeated washing and writing/rewriting rituals. Family history was notable for a maternal grandmother with attention-deficit/hyperactivity disorder (ADHD) and a father with repetitive eye-blinking and possible childhood obsessive-compulsive disorder (OCD). He had a normal birth followed by normal developmental milestones. Neurologic examination including smooth pursuit and voluntary saccadic eye movements was unremarkable.

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We previously established the contribution of de novodamaging sequence variants to Tourette disorder (TD) through whole-exome sequencing of 511 trios. Here, we sequence an additional 291 TD trios and analyze the combined set of 802 trios. We observe an overrepresentation of de novodamaging variants in simplex, but not multiplex, families; we identify a high-confidence TD risk gene, CELSR3(cadherin EGF LAG seven-pass G-type receptor 3); we find that the genes mutated in TD patients are enriched for those related to cell polarity, suggesting a common pathway underlying pathobiology; and we confirm a statistically significant excess of de novocopy number variants in TD. Finally, we identify significant overlap of de novosequence variants between TD and obsessive-compulsive disorder and de novocopy number variants between TD and autism spectrum disorder, consistent with shared genetic risk.