The major strength of this collaboration is the cooperation of the treatment and monitoring agencies with the overall goal of maintaining the offender in the community. Further research is needed to confirm the effectiveness of the clinical model in reducing recidivism and retaining clients.

Nine cases of congenital cardiovascular malformations (CCVM) with associated unbalanced structural chromosomal abnormalities were ascertained in a population‐based study of heart defects, constituting 0.4% of the 2,103 cases of CCVM in the Baltimore‐Washington Infant Study (BWIS). This represents a four‐fold increase over the general population rate. In an effort to determine possible phenotype/karyotype correlations, the literature was searched for cases with similar karyotypic abnormalities. This comparison of 223 literature cases of karyotypic abnormalities with nine similar cases ascertained by heart malformation has provided the opportunity to review cardiac defects reported in cases of structural abnormalities of chromosomes 1, 3, 7, 8, 9, 10, 11, 15, and 18. The most common cardiac malformation present in the chromosomal cases was ventricular septal defect (VSD) (39%); similarly VSD is the most common CCVM among children with heart defects, although it is the primary defect in only 20% of the BWIS cases. Among all heart defects in the BWIS, atrial septal defect (ASD) represents 5.5% of all cases, but in cases of 8p duplication, ASD is present in 41%. In addition, 40% of cases of 9p duplication had an ASD. Similarly, 35% of cases of 11q duplication had an ASD. While the suggestion of specific karyotype/phenotype associations is premature, information on additional cases might clarify the possibility that genetic determinants related to septum formation may reside on chromosome 8, 9, and/or 11. The variety of chromosomal abnormalities in cases with ventricular septal defect indicates one type of genetic heterogeneity that may be involved in this very common heart defect.

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There is a new and growing interest among community mental health providers and administrators in the area of correctional psychiatry. From a column in Psychiatric Times to committees and task forces in APA and the American Academy of Psychiatry and the Law, increased attention is being paid to the great need for the treatment of mentally ill offenders. In this article, we will introduce the reader to the magnitude of the correctional system and to the prevalence of mental illness in the correctional population. We will then describe several model programs designed to work with mentally disordered offenders, and outline a novel collaborative approach between a CMHC and a Probation Office designed to help mentally disordered offenders succeed in community treatment. Several barriers to treatment faced by this population will be identified, including double stigma, lack of family/social support, comorbidity, adjustment problems, and boundary issues. Case vignettes designed to illustrate key points will be included.

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