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Susan Hatters Friedman

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Susan Hatters Friedman, MD discusses MISTAKES WRITERS MAKE ABOUT FORENSIC PSYCHIATRY AND HOW TO AVOID THEM. She talks about the differences between forensic psychiatry and forensic psychology; the rules governing psychiatric confidentiality; the fact that forensic psychiatrists are not lie detectors; the depiction of competency versus sanity in fiction (and which is easier to argue in court); and lines a psychiatrist (at least a reputable one) wouldn't cross. Do any of those topics pique your interest? Check out 2 MINUTES OF INDY https://bit.ly/2MinutesOfIndy, where over the week following the airing of the episode, you'll find brief video clips from the interview on each of those topics. You can also catch up on some highlights of previous episodes there. For a transcript of this interview and links to more information, go to https://www.theindyauthor.com/podcast.html. Did you find the information in this video useful? Please consider supporting The Indy Author! https://www.patreon.com/theindyauthor https://www.buymeacoffee.com/mattydalrymple Susan Hatters Friedman is a psychiatrist specializing in forensic psychiatry and maternal mental health. She currently serves as President of the American Academy of Psychiatry and the Law. Susan received the Manfred Guttmacher Award from the American Psychiatric Association for editing the book “Family Murder: Pathologies of Love and Hate.” She is pursuing a Masters in Crime Fiction at the University of Cambridge and has studied with The Second City, the world's premier comedy club, comedy theater, and school of improvisation. Her creative writing is found in “Hobart,” “Eclectica," and “Drunk Monkeys,” among others.

Susan Hatters Friedman, MD discusses MISTAKES WRITERS MAKE ABOUT FORENSIC PSYCHIATRY AND HOW TO AVOID THEM. She talks about the differences between forensic psychiatry and forensic psychology; the rules governing psychiatric confidentiality; the fact that forensic psychiatrists are not lie detectors; the depiction of competency versus sanity in fiction (and which is easier to argue in court); and lines a psychiatrist (at least a reputable one) wouldn't cross. Do any of those topics pique your interest? Check out 2 MINUTES OF INDY <a href="https://bit.ly/2MinutesOfIndy" rel="nofollow" target="_blank">https://bit.ly/2MinutesOfIndy</a>, where over the week following the airing of the episode, you'll find brief video clips from the interview on each of those topics. You can also catch up on some highlights of previous episodes there. For a transcript of this interview and links to more information, go to <a href="https://www.theindyauthor.com/podcast.html" rel="nofollow" target="_blank">https://www.theindyauthor.com/podcast.html</a>. Did you find the information in this video useful? Please consider supporting The Indy Author! <a href="https://www.patreon.com/theindyauthor" rel="nofollow" target="_blank">https://www.patreon.com/theindyauthor</a> <a href="https://www.buymeacoffee.com/mattydalrymple" rel="nofollow" target="_blank">https://www.buymeacoffee.com/mattydalrymple</a> Susan Hatters Friedman is a psychiatrist specializing in forensic psychiatry and maternal mental health. She currently serves as President of the American Academy of Psychiatry and the Law. Susan received the Manfred Guttmacher Award from the American Psychiatric Association for editing the book “Family Murder: Pathologies of Love and Hate.” She is pursuing a Masters in Crime Fiction at the University of Cambridge and has studied with The Second City, the world's premier comedy club, comedy theater, and school of improvisation. Her creative writing is found in “Hobart,” “Eclectica," and “Drunk Monkeys,” among others.

Mistakes Writers Make about Forensic Psychiatry and How to Avoid Them with Susan Hatters Friedman - #139

Susan Hatters Friedman, MD, returns to the MDedge Psychcast  to join host Lorenzo Norris, MD,  to discuss postpartum psychosis.  Dr. Hatters Friedman is the Phillip J. Resnick Professor of Forensic Psychiatry at Case Western Reserve University in Cleveland. She also is professor of pediatrics and reproductive biology, and adjunct professor of law at Case Western. In addition, Dr. Hatters Friedman and colleagues recently wrote an article published in Current Psychiatry examining this topic,  Postpartum psychosis: Protecting mother and infant. Timestamps:  This week in psychiatry (01:09) Interview (05:07) Dr. RK (22:07)  Show notes by Jacqueline Posada, MD, consultation-liaison psychiatry fellow with the Inova Fairfax Hospital/George Washington University program in Falls Church, Va.   Overview of postpartum psychosis    Postpartum psychosis is a medical emergency with a fulminant development occurring within 1-4 weeks after delivery. Onset is usually 3-10 days postpartum, and women experience a spectrum of symptoms from psychosis to dysphoric mania and confusion. Many women who experience postpartum psychosis do not have a past psychiatric history, although they might go on to develop bipolar disorder. Symptoms change quickly, with risks of devastating consequences. A woman with postpartum psychosis might minimize or even conceal her symptoms to avoid being separated from her child or out of fear that her child will be taken away. Collateral information is extremely important. A woman is at the greatest risk of developing a mental illness in the period around childbirth. The rate of postpartum depression is 1 in 9, and the baseline rate of postpartum psychosis is 1/500. Women with bipolar disorder (which may be undiagnosed until the postpartum psychosis) or a previous episode of postpartum psychosis are at highest risk of postpartum psychosis.  Prevention and intervention  Clinicians must be proactive with their psychoeducation about pregnancy, contraception, and the natural course of mental disorders during pregnancy and postpartum. If a patient with bipolar disorder is of childbearing age, the clinician should consider having her on medications that are relatively safe during pregnancy. In 2011, 45% of pregnancies in the United States were unintended; thus, preconception counseling is necessary. Medications for bipolar disorder can help prevent postpartum psychosis. Other preventive measures include using sleep strategies after childbirth, such as arranging support to assist at night and weighing the risks of breastfeeding. Breastfeeding can lead to sleep deprivation, which in turn, increases the risk of decompensation. If a woman wants to breastfeed, the psychiatrist should be in touch with the pediatrician and plan for breastfeeding by having the mother on medications that are safe for breastfeeding. Involuntary hospitalization might be required if the postpartum psychosis puts the mother or child at imminent risk of harm. Family and nonpsychiatrists on the health care team might be resistant to psychiatric hospitalization because it would mean separating the mother from the child. Psychiatrists can broach resistance by explaining the details of a thorough risk assessment and emphasizing that, while bonding is important, the hospitalization is meant to prevent the worst outcomes of suicide or infanticide.  Review of key points  Postpartum psychosis can present with mood symptoms or delirium, so those signs should make a clinician vigilant for postpartum psychosis. The symptoms of postpartum psychosis change rapidly with escalating danger, such as infanticide and suicide, so collateral from family and speedy treatment are essential. Focused early collaboration and education with team member such as ob.gyns. and pediatricians help make future interventions go more smoothly.    References Friedman SH et al. Postpartum psychosis: Protecting mother and infant.  Curr Psychiatr. 2019 Apr 1;18(4):13-21. Sit D et al. A review of postpartum psychosis.  J Womens Health (Larchmt). 2006 May;15(4):352-68. Harlow BL et al. Incidence of hospitalization for postpartum psychosis and bipolar episodes in women with and without prior prepregnancy or prenatal psychiatric hospitalizations.  Arch Gen Psychiatry. 2007;64(1):42-8.   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgePsych

Susan Hatters Friedman, MD, returns to the MDedge Psychcast  to join host <a href="https://www.gwdocs.com/find-a-doctor/lorenzo-norris-md/" rel="nofollow" target="_blank">Lorenzo Norris, MD</a>,  to discuss postpartum psychosis. <a href="https://www.uhhospitals.org/services/psychiatry/medical-education/faculty/susan-hatters-friedman-md" rel="nofollow" target="_blank"> Dr. Hatters Friedman</a> is the Phillip J. Resnick Professor of Forensic Psychiatry at Case Western Reserve University in Cleveland. She also is professor of pediatrics and reproductive biology, and adjunct professor of law at Case Western. In addition, Dr. Hatters Friedman and colleagues recently wrote an article published in Current Psychiatry examining this topic, <a href="https://www.mdedge.com/psychiatry/article/197703/schizophrenia-other-psychotic-disorders/postpartum-psychosis-protecting?channel=133" rel="nofollow" target="_blank"> Postpartum psychosis: Protecting mother and infant</a>. Timestamps: <ul> <li>This week in psychiatry (01:09)</li> <li>Interview (05:07)</li> <li>Dr. RK (22:07)</li> </ul> Show notes by Jacqueline Posada, MD, consultation-liaison psychiatry fellow with the Inova Fairfax Hospital/George Washington University program in Falls Church, Va. Overview of postpartum psychosis <ul> <li>Postpartum psychosis is a medical emergency with a fulminant development occurring within 1-4 weeks after delivery.</li> <li>Onset is usually 3-10 days postpartum, and women experience a spectrum of symptoms from psychosis to dysphoric mania and confusion. Many women who experience postpartum psychosis do not have a past psychiatric history, although they might go on to develop bipolar disorder.</li> <li>Symptoms change quickly, with risks of devastating consequences. A woman with postpartum psychosis might minimize or even conceal her symptoms to avoid being separated from her child or out of fear that her child will be taken away. Collateral information is extremely important.</li> <li>A woman is at the greatest risk of developing a mental illness in the period around childbirth. The rate of postpartum depression is 1 in 9, and the baseline rate of postpartum psychosis is 1/500. Women with bipolar disorder (which may be undiagnosed until the postpartum psychosis) or a previous episode of postpartum psychosis are at highest risk of postpartum psychosis.</li> </ul> Prevention and intervention <ul> <li>Clinicians must be proactive with their psychoeducation about pregnancy, contraception, and the natural course of mental disorders during pregnancy and postpartum. If a patient with bipolar disorder is of childbearing age, the clinician should consider having her on medications that are relatively safe during pregnancy. In 2011, 45% of pregnancies in the United States were unintended; thus, preconception counseling is necessary.</li> <li>Medications for bipolar disorder can help prevent postpartum psychosis. Other preventive measures include using sleep strategies after childbirth, such as arranging support to assist at night and weighing the risks of breastfeeding. Breastfeeding can lead to sleep deprivation, which in turn, increases the risk of decompensation.</li> <li>If a woman wants to breastfeed, the psychiatrist should be in touch with the pediatrician and plan for breastfeeding by having the mother on medications that are safe for breastfeeding.</li> <li>Involuntary hospitalization might be required if the postpartum psychosis puts the mother or child at imminent risk of harm. Family and nonpsychiatrists on the health care team might be resistant to psychiatric hospitalization because it would mean separating the mother from the child.</li> <li>Psychiatrists can broach resistance by explaining the details of a thorough risk assessment and emphasizing that, while bonding is important, the hospitalization is meant to prevent the worst outcomes of suicide or infanticide.</li> </ul> Review of key points <ul> <li>Postpartum psychosis can present with mood symptoms or delirium, so those signs should make a clinician vigilant for postpartum psychosis.</li> <li>The symptoms of postpartum psychosis change rapidly with escalating danger, such as infanticide and suicide, so collateral from family and speedy treatment are essential.</li> <li>Focused early collaboration and education with team member such as ob.gyns. and pediatricians help make future interventions go more smoothly.</li> </ul> References Friedman SH et al. Postpartum psychosis: Protecting mother and infant. <a href="https://www.mdedge.com/psychiatry/article/197703/schizophrenia-other-psychotic-disorders/postpartum-psychosis-protecting" rel="nofollow" target="_blank"> Curr Psychiatr. 2019 Apr 1;18(4):13-21</a>. Sit D et al. A review of postpartum psychosis. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3109493/pdf/nihms294422.pdf" rel="nofollow" target="_blank"> J Womens Health (Larchmt). 2006 May;15(4):352-68</a>. Harlow BL et al. Incidence of hospitalization for postpartum psychosis and bipolar episodes in women with and without prior prepregnancy or prenatal psychiatric hospitalizations. <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/209983" rel="nofollow" target="_blank"> Arch Gen Psychiatry. 2007;64(1):42-8</a>. For more MDedge Podcasts, go to <a href="https://www.mdedge.com/podcasts" rel="nofollow" target="_blank">mdedge.com/podcasts</a> Email the show: <a href="mailto:podcasts@mdedge.com">podcasts@mdedge.com</a> Interact with us on Twitter: <a href="https://twitter.com/MDEdgePsych" rel="nofollow" target="_blank">@MDedgePsych</a>

Identifying and treating postpartum psychosis with Dr. Susan Hatters Friedman

Susan Hatters Friedman, MD, joins Lorenzo Norris, MD, host of the MDedge Psychcast and editor in chief of MDedge Psychiatry, to talk about family murder.   Dr. Hatters Friedman is the Phillip J. Resnick Professor of Forensic Psychiatry at Case Western Reserve University in Cleveland. She also is professor of pediatrics and reproductive biology, and adjunct professor of law at Case Western. In addition, Dr. Hatters Friedman is editor of Family Murder: Pathologies of Love and Hate, which was written by the Group for the Advancement of Psychiatry’s Committee on Psychiatry &amp; Law. Show notes by Jacqueline Posada, MD, consultation-liaison psychiatry fellow with the Inova Fairfax Hospital/George Washington University program in Falls Church, Va. Overview of family murder   Family murder is defined as situations in which any member of a family kills another family member. It encompasses a wide scope of violence that includes intimate partner homicide; infanticide, including purposeful feticide; neonaticide (murder in first day of life); siblicide; and parricide (a child killing a parent).    The book, Family Murder: Pathologies of Love and Hate, discusses the epidemiology and public health implications of family murder, various motivations, and pertinent psychiatric assessments, including risk assessments and sanity evaluations. It was written to prompt better screening and risk assessments, with the goal of prevention.   Motivating factors leading to murder   Phillip J. Resnick, MD, who also works in forensic psychiatry at Case Western, identified five main motives of parent-child violence.   Fatal maltreatment is the result of fatal neglect or abuse by a parent. This type of family murder is common and is most likely to be prevented, especially with intervention by Child Protective Services. Altruistic murder occurs in three categories in which a parent wants to spare a child from perceived suffering:   Psychotic parents with delusions about their children being harmed. Murder-suicide, such as when a severely depressed and suicidal parent kills their child to avoid leaving them without a parent after their suicide. Parents who kill a child with serious, chronic physical illness as a means of “saving” the child from a “worse” fate.   Acutely psychotic murder occurs in the context of serious mental illness such as schizophrenia, bipolar disorder, or postpartum psychosis. Preventing this type of murder means monitoring the content of delusions and hallucinations related to family members. The Andrea Yates murders are a prime example of this type of murder. Unwanted child motive is most common in neonaticide cases. The child is considered a hindrance to something the parent wants, such as a relationship. To screen for this risk, physicians can ask whether the pregnancy was planned and observe the interaction between child and parent, especially during the first hours to days of life. Partner revenge is rare but is most likely to occur in context of a custody battle, with one partner seeing murder as a means of revenge. Psychiatrists can observe interactions between partners and inquire about threats from partners.  Screening and preventing violence   Psychiatrists can screen for violence by asking: “How are disagreements handled in your family?” This broad, neutral question elucidates family dynamics about partner violence, anger, and negative parental practices. It can generate information aimed at preventing fatal outcomes. Strong human emotions, such as anger, jealousy, and pride, combined with risk factors such as a history of violence and access to weapons, drive family murder. Psychoeducation about childhood development can decrease the risk of violence, especially in the fatal maltreatment category.  Addressing countertransference issues   Family murder stimulates strong countertransference in response to the perpetrator. Working as a team can diffuse these emotions and allows a venue for processing. Building rapport with patients and recognizing their humanity by using phrases such as “When he died,” rather than “When you killed him.”    References  Family Murder: Pathologies of Love and Hate. Group for the Advancement of Psychiatry, 2018. Hatters Friedman S. Filicide-suicide: Common factors in parents who kill their children and themselves. J Am Acad Psychiatry Law. 2005 Jan. 33(4):496-504.   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgePsych

Susan Hatters Friedman, MD, joins <a href="https://www.gwdocs.com/find-a-doctor/lorenzo-norris-md/" rel="nofollow" target="_blank">Lorenzo Norris, MD</a>, host of the MDedge Psychcast and editor in chief of MDedge Psychiatry, to talk about family murder.  <a href="https://www.uhhospitals.org/services/psychiatry/medical-education/faculty/susan-hatters-friedman-md" rel="nofollow" target="_blank"> Dr. Hatters Friedman</a> is the Phillip J. Resnick Professor of Forensic Psychiatry at Case Western Reserve University in Cleveland. She also is professor of pediatrics and reproductive biology, and adjunct professor of law at Case Western. In addition, Dr. Hatters Friedman is editor of <a href="https://www.appi.org/Family_Murder" rel="nofollow" target="_blank">Family Murder: Pathologies of Love and Hate</a>, which was written by the Group for the Advancement of Psychiatry’s Committee on Psychiatry &amp; Law. Show notes by Jacqueline Posada, MD, consultation-liaison psychiatry fellow with the Inova Fairfax Hospital/George Washington University program in Falls Church, Va. Overview of family murder  <ul> <li>Family murder is defined as situations in which any member of a family kills another family member. It encompasses a wide scope of violence that includes intimate partner homicide; infanticide, including purposeful feticide; neonaticide (murder in first day of life); siblicide; and parricide (a child killing a parent). </li> </ul> <ul> <li>The book, <a href="https://www.appi.org/Family_Murder" rel="nofollow" target="_blank">Family Murder: Pathologies of Love and Hate</a>, discusses the epidemiology and public health implications of family murder, various motivations, and pertinent psychiatric assessments, including risk assessments and sanity evaluations. It was written to prompt better screening and risk assessments, with the goal of prevention. </li> </ul> Motivating factors leading to murder  <a href="https://www.uhhospitals.org/services/psychiatry/medical-education/forensic-psychiatry-fellowship/faculty/phillip-resnick-md" rel="nofollow" target="_blank"> Phillip J. Resnick, MD</a>, who also works in forensic psychiatry at Case Western, identified five main motives of parent-child violence.  <ol> <li>Fatal maltreatment is the result of fatal neglect or abuse by a parent. This type of family murder is common and is most likely to be prevented, especially with intervention by Child Protective Services.</li> <li>Altruistic murder occurs in three categories in which a parent wants to spare a child from perceived suffering:</li> </ol> <ul> <li>Psychotic parents with delusions about their children being harmed.</li> <li>Murder-suicide, such as when a severely depressed and suicidal parent kills their child to avoid leaving them without a parent after their suicide.</li> <li>Parents who kill a child with serious, chronic physical illness as a means of “saving” the child from a “worse” fate.</li> </ul> <ol> <li>Acutely psychotic murder occurs in the context of serious mental illness such as schizophrenia, bipolar disorder, or postpartum psychosis. Preventing this type of murder means monitoring the content of delusions and hallucinations related to family members. The <a href="https://www.biography.com/crime-figure/andrea-yates" rel="nofollow" target="_blank">Andrea Yates</a> murders are a prime example of this type of murder.</li> <li>Unwanted child motive is most common in neonaticide cases. The child is considered a hindrance to something the parent wants, such as a relationship. To screen for this risk, physicians can ask whether the pregnancy was planned and observe the interaction between child and parent, especially during the first hours to days of life.</li> <li>Partner revenge is rare but is most likely to occur in context of a custody battle, with one partner seeing murder as a means of revenge. Psychiatrists can observe interactions between partners and inquire about threats from partners.</li> </ol> Screening and preventing violence  <ul> <li>Psychiatrists can screen for violence by asking: “How are disagreements handled in your family?” This broad, neutral question elucidates family dynamics about partner violence, anger, and negative parental practices. It can generate information aimed at preventing fatal outcomes.</li> <li>Strong human emotions, such as anger, jealousy, and pride, combined with risk factors such as a history of violence and access to weapons, drive family murder.</li> <li>Psychoeducation about childhood development can decrease the risk of violence, especially in the fatal maltreatment category.</li> </ul> Addressing countertransference issues  <ul> <li>Family murder stimulates strong countertransference in response to the perpetrator. Working as a team can diffuse these emotions and allows a venue for processing.</li> <li>Building rapport with patients and recognizing their humanity by using phrases such as “When he died,” rather than “When you killed him.”</li> </ul> References  <a href="https://www.appi.org/Family_Murder" rel="nofollow" target="_blank">Family Murder: Pathologies of Love and Hate</a>. Group for the Advancement of Psychiatry, 2018. Hatters Friedman S. Filicide-suicide: Common factors in parents who kill their children and themselves. <a href="http://jaapl.org/content/33/4/496" rel="nofollow" target="_blank">J Am Acad Psychiatry Law. 2005 Jan. 33(4):496-504</a>. For more MDedge Podcasts, go to <a href="https://www.mdedge.com/podcasts" rel="nofollow" target="_blank">mdedge.com/podcasts</a> Email the show: <a href="mailto:podcasts@mdedge.com">podcasts@mdedge.com</a> Interact with us on Twitter: <a href="https://twitter.com/MDEdgePsych" rel="nofollow" target="_blank">@MDedgePsych</a>