Full Mental Status Exam

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In her Presidential address, Dr. Recupero shows us how the Internet and changes in electronic communications have affected the forensic evaluation process in multiple ways. These developments provide the forensic psychiatrist with new tools and new sources of information, and their novelty brings about new challenges and opportunities. This commentary focuses on the use of information and communication technology (ICT) for purposes of obtaining collateral information in addition to a sample of other likely uses of ICT in the practice of forensic psychiatry. Collateral information from electronic communications such as e-mails, web postings, texting, and social networking sites provides useful data but also raises challenges in interpretation. Digital information about the expert can be used by cross-examining attorneys. Electronic tools can help the forensic psychiatrist to be more efficient. Correctional systems have a great deal to gain by adopting more efficient information systems. Continuing evolution of these technologies assures that we can expect more rapid change in these areas in the future.

Patricia Recupero, MD, has presented in a very clear manner the increasing relevance of the Internet in day-to-day psychiatric practice, as well as in forensic evaluations. For the more senior forensic psychiatrists, it is only a little amusing to read peer-reviewed journal articles from just eight years ago that provide introductory information regarding the Internet, search engines, and medical gateways., For those of us who now do not immediately recognize the acronyms PIU (problematic internet use), SNS (social networking sites), CMC (computer-mediated communication), and ICT (information and communication technology), Recupero's comprehensive review serves as a reminder of our professional need to be technologically relatively current or risk falling behind in the context of evolving forensic evaluation standards. For instance, most standard psychiatric examinations include questions relevant to support systems, coping styles, hobbies, and other leisure activities, to help in assessing psychiatric symptoms and associated impairments. Recupero's suggested questions that focus on the evaluee's use of the Internet are those that are likely in the near future to be asked routinely as part of the examiner's inquiry regarding these areas.

Collateral Information

Obtaining collateral information as part of a forensic examination is a standard of practice in almost all forensic contexts. An evolving element of forensic examinations is the rapid growth of the use of ICT for purposes of obtaining collateral information, and this aspect is the focus of this commentary, in addition to a sample of other likely uses of ICT in the practice of forensic psychiatry.

The AAPL Practice Guideline for Forensic Psychiatric Evaluation of Defendants Raising the Insanity Defense emphasizes the importance of obtaining collateral information, which includes police reports; relevant psychiatric, substance abuse, and medical records; school, military, and work records; other expert evaluations and testimony; custodial records; personal records such as financial transactions; psychological testing; results of brain imaging and other special procedures; photographs; audiotapes; and videotapes. A word search of the 2002 AAPL guideline would not turn up the terms electronic, computer, digital, or technology, all of which would be found if the document were revised today. McGrath and Casey provide a primer pertinent to forensic psychiatry and the Internet with a very useful introduction to digital evidence. Similar to Recupero, these authors were not suggesting that forensic psychiatrists become high-technology experts and spend their time searching for digital evidence of crimes. However, they should be educated about ICT to know when to use it. The process of obtaining such information should be managed by the attorneys via the discovery process and the use of computer experts.

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