Alexithymic and nonalexithymic hypertensives were assessed for severity of hypertension using a weighting system based on diastolic blood pressure, optic fundi, ECG, chest X ray, renal studies, and patient history. Outpatient hypertensives (diastolic blood pressure > 95 mm Hg) were selected as subjects because they are largely asymptomatic; thus, focusing on somatic ills to the exclusion of thoughts about emotions is not likely to be due to their hypertensive pathology but rather reflects psychological constitution. Controlling for age differences, it was found that alexithymics manifested more severe hypertensive sequelae than did nonalexithymics; there was, however, no difference in severity of atherosclerosis. The results suggest that alexithymia is not only correlated with hypertension but may also play a role in its etiology.

Violence risk assessments are a critical element of dispositional decisions with individuals adjudicated Not Guilty by Reason of Insanity (Shah, 1978). Given societal perceptions that mentally ill individuals are particularly dangerous (Bonta, Law, & Hanson, 1998), it is not surprising that careful scrutiny is given to individuals who are mentally ill and have already committed criminal acts. Mental health professionals are asked to accurately differentiate insanity acquittees who are likely to be violent in the community from those who are safe to be returned to the community (Foucha v. Louisiana, 1992). Further, these professionals are often asked to identify the patterns of expected violence (type, density, variety, circumstances, etc.) so that appropriate risk management plans may be developed. However, violence research focused on insanity acquittees has been limited, and reliable, valid violence risk assessment methodologies for this specialized population are not well defined. Foundational research is needed to begin the process of developing such methodologies. Historically, studies of risk factors for future violence have often been based upon earlier studies of risk factors for past violence (e.g., Quinsey, Harris, Rice, & Cormier, 1998). Psychopathy, Violence, & General OffendersHare (1980, 1991) developed the Psychopathy Checklist (PCL) and the Psychopathy Checklist -Revised (PCL-R) to assess the psychopathic personality. A briefer screening version of the measure was also later developed (PCL:SV; Hart, Cox, & Hare, 1995). Psychopaths identified by high PCL scores have histories of more varied, more frequent, and more severe types of violence both in the community and, to a lesser degree, in institutional settings (

This chapter is a pragmatic discussion of the experience of working as a psychiatrist in correctional settings, whether jails or prisons. To work inside the walls, the psychiatrist must come to terms with the realities of the correctional setting in order to be secure, satisfied with the work, and clinically effective. There is no monolithic correctional culture. Each system and facility has its own unique culture and has evolved in some degree of isolation, emphasizing different philosophical approaches to the correctional mission and to criminal causation. This chapter examines the context in which clinical work is embedded: physical environment and security, correctional culture, personal safety, typical stressors, and individual liability. It is clearly not for everybody but the rewards can be tremendous. The quality of care in many facilities, especially prisons, is superior to care in the community. The clinical problems are unendingly fascinating. And, despite its downsides, having a setting with limited access to drugs that provides food, clothing, shelter, and medical care can allow a degree of patient improvement that may be difficult to realize in the community. Opportunities for creativity in treatment and program development are unparalleled. In many ways, correctional psychiatry is poised to lead the way in the treatment of some of the most ill and behaviorally disordered members of society.

The Second Edition of Principles and Practice of Forensic Psychiatry is a most welcome addition to the forensic literature. Richard Rosner and a talented and diverse group of authors and co-editors have offered up what can only be described as the most definitive exposition of the whole of forensic psychiatry as practiced in the United States. Most notable is that it is a significant improvement on what was already the leading text of its kind. It retains, and even adds to, the breadth and accessibility needed to function as a reference text for diverse professionals while offering more depth and nuance to the experienced forensic practitioner. It is also a much more lively read, perhaps reflecting both the seasoning of the many authors who refined their chapters from the First Edition and the addition of authors in some chapters.

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