James Knoll - Academia.edu (original) (raw)
Papers by James Knoll
Journal of forensic sciences, 2015
Homicide-suicide represents a single episode of violence which may decimate an entire family. Thi... more Homicide-suicide represents a single episode of violence which may decimate an entire family. This study aimed to further describe motives and context of these tragedies. Psychological autopsies were completed for 18 homicide-suicide cases in Dallas, Texas. This included postevent interviews with surviving family members and review of police and coroner records. Two-thirds of perpetrators had made either verbal or written threats prior to the homicide-suicide. A simplified typology describing victim-perpetrator relationship and motive type is suggested for future studies and clinical ease. Two-thirds of perpetrators fell into the category of Intimate-Possessive, most of whom were depressed men who were abusing substances and undergoing separation. Additional categories included Intimate-Ailing, Filial-Revenge, Familial-Psychotic, and Friend-Psychotic. Further, implications from this psychological autopsy study regarding risk assessment include use of collateral interviews regarding ...
Schizophrenia Bulletin, 1998
Whereas etiological heterogeneity of the various types of schizophrenia has been repeatedly propo... more Whereas etiological heterogeneity of the various types of schizophrenia has been repeatedly proposed, relatively few attempts have been made to separate the component diseases. Using a strategy focusing on bimodal distributions within several relevant domains of schizophrenia, we demonstrate that currently available data on schizophrenia patients are consistent with the hypothesis that some of these patients have an ongoing neurodegenerative
Frontiers in Psychiatry, 2015
School shooters present a challenge to both forensic psychiatry and law enforcement agencies. The... more School shooters present a challenge to both forensic psychiatry and law enforcement agencies. The relatively small number of school shooters, their various characteristics, and the lack of in-depth analysis of all of the shooters prior to the shooting add complexity to our understanding of this problem. In this short paper, we introduce a new methodology for automatically profiling school shooters. The methodology involves automatic analysis of texts and the production of several measures relevant for the identification of the shooters. Comparing texts written by 6 school shooters to 6056 texts written by a comparison group of male subjects, we found that the shooters' texts scored significantly higher on the Narcissistic Personality dimension as well as on the Humilated and Revengeful dimensions. Using a ranking/prioritization procedure, similar to the one used for the automatic identification of sexual predators, we provide support for the validity and relevance of the proposed methodology.
The journal of the American Academy of Psychiatry and the Law, 2010
In Indiana v. Edwards, the U.S. Supreme Court held that a higher standard may be required for pro... more In Indiana v. Edwards, the U.S. Supreme Court held that a higher standard may be required for pro se competence (PSC) than for competence to stand trial (CST). However, the Court refrained from elaborating a specific standard. The trial judge is in the best position to make more fine-tuned mental capacity decisions. This pilot study surveyed trial judges' opinions about PSC to help forensic evaluators structure their assessments. Eighteen of 400 New York State trial judges surveyed replied. Trial judges regarded disorders of cognitive impairment (n = 10) and psychosis (n = 4) to be potentially limiting for PSC. Responses relating to which domains should be assessed were heterogeneous, but the most common were intellectual and analytic abilities (n = 10), legal knowledge/experience (n = 9), and language abilities (n = 8). Several judges listed factors that are not traditionally part of CST evaluations, such as having a rational reason for proceeding pro se and a willingness to ac...
Behavioral Sciences & the Law, 2015
Identification is one of eight warning behaviors-superordinate patterns of accelerating risk-that... more Identification is one of eight warning behaviors-superordinate patterns of accelerating risk-that are theorized to correlate with targeted violence, and have some empirical validation. It is characterized by one or more of five characteristics: pseudo-commando behavior, evidence of a warrior mentality, a close association with weapons or other military or law enforcement paraphernalia, wanting to imitate and often surmount previous attackers or assassins, or believing oneself to be an agent to advance a particular cause or belief system. The authors briefly explore the history of the psychology of identification, its current usage, and its application to threat assessment. Four cases are used to illustrate identification as both a process and a product, and a likely motive for targeted violence in some subjects. Its operational relevance for threat assessment is suggested. Copyright © 2015 John Wiley & Sons, Ltd.
Psychiatric Clinics of North America, 2003
Aggression among patients with serious mental illness occurs relatively infrequently, but it is a... more Aggression among patients with serious mental illness occurs relatively infrequently, but it is a significant concern for patients, relatives, mental health professionals, and the public. Recognition of this risk and providing access and continuity of appropriate psychiatric care should be major clinical and administrative objectives in the management of violence in psychotic patients. To date, pharmacologic approaches have been unclear and inconsistent. At present, typical antipsychotics continue to have a primary role in acute management and in long-term management, in which noncompliance necessitates the use of long-acting depot neuroleptic preparations. Atypical antipsychotics in acute and long-acting intramuscular forms doubtless will influence and expand the choice for acute management of hostile psychotic patients and the long-term management of poorly compliant patients who are at risk to become violent on relapse. Persistent aggression should be managed by atypical antipsychotics with a preferential indication for clozapine, for which the most data on efficacy are available. The role of adjunctive medications is presently unclear. A major focus of care should be to refine legal processes and to conduct intervention studies aimed at enhancing treatment compliance. Violence risk reduction is not only crucial from a societal perspective, but also it is a humanitarian necessity to alleviate the burden and stigma for patients with serious mental illness.
Journal of Affective Disorders, 1998
Background: Gabapentin is an anticonvulsant proposed to have mood-stabilizing properties. It has ... more Background: Gabapentin is an anticonvulsant proposed to have mood-stabilizing properties. It has been effective in the add-on treatment of refractory partial seizures and secondary generalized tonic-clonic seizures. It has the advantage of a favorable side effect profile and lack of drug interactions. Methods: Twelve consecutive outpatients with persistent, treatment-resistant bipolar spectrum disorders were treated with gabapentin in combination with other medications. Patients were started at 300 mg / day, which was titrated according to clinical response. Response was assessed every 3-4 weeks with a Clinical Global Improvement Scale. Dosage and side effects were noted. The median peak dose was 2400 mg / day. Results: One patient had a marked response to gabapentin; seven, a moderate response; two, mild; and two, no response to treatment. Six patients discontinued treatment due to somatic complaints (i.e., sedation or fatigue). The most frequently reported adverse effect was sedation. Limitations: Gabapentin was added openly, and rating was nonblind in this case series. The use of concomitant medications could have increased the amount of sedation experienced with gabapentin. Conclusion: Overall, gabapentin was associated with moderate improvement of mood symptoms. Given the severity and chronicity of these patients' illness, a moderate response must be considered a relative success. Controlled studies of gabapentin are needed to clarify its role in the treatment of bipolar disorder.
The journal of the American Academy of Psychiatry and the Law, 2015
Journal of forensic sciences, 2015
Homicide-suicide represents a single episode of violence which may decimate an entire family. Thi... more Homicide-suicide represents a single episode of violence which may decimate an entire family. This study aimed to further describe motives and context of these tragedies. Psychological autopsies were completed for 18 homicide-suicide cases in Dallas, Texas. This included postevent interviews with surviving family members and review of police and coroner records. Two-thirds of perpetrators had made either verbal or written threats prior to the homicide-suicide. A simplified typology describing victim-perpetrator relationship and motive type is suggested for future studies and clinical ease. Two-thirds of perpetrators fell into the category of Intimate-Possessive, most of whom were depressed men who were abusing substances and undergoing separation. Additional categories included Intimate-Ailing, Filial-Revenge, Familial-Psychotic, and Friend-Psychotic. Further, implications from this psychological autopsy study regarding risk assessment include use of collateral interviews regarding ...
Schizophrenia Bulletin, 1998
Whereas etiological heterogeneity of the various types of schizophrenia has been repeatedly propo... more Whereas etiological heterogeneity of the various types of schizophrenia has been repeatedly proposed, relatively few attempts have been made to separate the component diseases. Using a strategy focusing on bimodal distributions within several relevant domains of schizophrenia, we demonstrate that currently available data on schizophrenia patients are consistent with the hypothesis that some of these patients have an ongoing neurodegenerative
Frontiers in Psychiatry, 2015
School shooters present a challenge to both forensic psychiatry and law enforcement agencies. The... more School shooters present a challenge to both forensic psychiatry and law enforcement agencies. The relatively small number of school shooters, their various characteristics, and the lack of in-depth analysis of all of the shooters prior to the shooting add complexity to our understanding of this problem. In this short paper, we introduce a new methodology for automatically profiling school shooters. The methodology involves automatic analysis of texts and the production of several measures relevant for the identification of the shooters. Comparing texts written by 6 school shooters to 6056 texts written by a comparison group of male subjects, we found that the shooters' texts scored significantly higher on the Narcissistic Personality dimension as well as on the Humilated and Revengeful dimensions. Using a ranking/prioritization procedure, similar to the one used for the automatic identification of sexual predators, we provide support for the validity and relevance of the proposed methodology.
The journal of the American Academy of Psychiatry and the Law, 2010
In Indiana v. Edwards, the U.S. Supreme Court held that a higher standard may be required for pro... more In Indiana v. Edwards, the U.S. Supreme Court held that a higher standard may be required for pro se competence (PSC) than for competence to stand trial (CST). However, the Court refrained from elaborating a specific standard. The trial judge is in the best position to make more fine-tuned mental capacity decisions. This pilot study surveyed trial judges' opinions about PSC to help forensic evaluators structure their assessments. Eighteen of 400 New York State trial judges surveyed replied. Trial judges regarded disorders of cognitive impairment (n = 10) and psychosis (n = 4) to be potentially limiting for PSC. Responses relating to which domains should be assessed were heterogeneous, but the most common were intellectual and analytic abilities (n = 10), legal knowledge/experience (n = 9), and language abilities (n = 8). Several judges listed factors that are not traditionally part of CST evaluations, such as having a rational reason for proceeding pro se and a willingness to ac...
Behavioral Sciences & the Law, 2015
Identification is one of eight warning behaviors-superordinate patterns of accelerating risk-that... more Identification is one of eight warning behaviors-superordinate patterns of accelerating risk-that are theorized to correlate with targeted violence, and have some empirical validation. It is characterized by one or more of five characteristics: pseudo-commando behavior, evidence of a warrior mentality, a close association with weapons or other military or law enforcement paraphernalia, wanting to imitate and often surmount previous attackers or assassins, or believing oneself to be an agent to advance a particular cause or belief system. The authors briefly explore the history of the psychology of identification, its current usage, and its application to threat assessment. Four cases are used to illustrate identification as both a process and a product, and a likely motive for targeted violence in some subjects. Its operational relevance for threat assessment is suggested. Copyright © 2015 John Wiley & Sons, Ltd.
Psychiatric Clinics of North America, 2003
Aggression among patients with serious mental illness occurs relatively infrequently, but it is a... more Aggression among patients with serious mental illness occurs relatively infrequently, but it is a significant concern for patients, relatives, mental health professionals, and the public. Recognition of this risk and providing access and continuity of appropriate psychiatric care should be major clinical and administrative objectives in the management of violence in psychotic patients. To date, pharmacologic approaches have been unclear and inconsistent. At present, typical antipsychotics continue to have a primary role in acute management and in long-term management, in which noncompliance necessitates the use of long-acting depot neuroleptic preparations. Atypical antipsychotics in acute and long-acting intramuscular forms doubtless will influence and expand the choice for acute management of hostile psychotic patients and the long-term management of poorly compliant patients who are at risk to become violent on relapse. Persistent aggression should be managed by atypical antipsychotics with a preferential indication for clozapine, for which the most data on efficacy are available. The role of adjunctive medications is presently unclear. A major focus of care should be to refine legal processes and to conduct intervention studies aimed at enhancing treatment compliance. Violence risk reduction is not only crucial from a societal perspective, but also it is a humanitarian necessity to alleviate the burden and stigma for patients with serious mental illness.
Journal of Affective Disorders, 1998
Background: Gabapentin is an anticonvulsant proposed to have mood-stabilizing properties. It has ... more Background: Gabapentin is an anticonvulsant proposed to have mood-stabilizing properties. It has been effective in the add-on treatment of refractory partial seizures and secondary generalized tonic-clonic seizures. It has the advantage of a favorable side effect profile and lack of drug interactions. Methods: Twelve consecutive outpatients with persistent, treatment-resistant bipolar spectrum disorders were treated with gabapentin in combination with other medications. Patients were started at 300 mg / day, which was titrated according to clinical response. Response was assessed every 3-4 weeks with a Clinical Global Improvement Scale. Dosage and side effects were noted. The median peak dose was 2400 mg / day. Results: One patient had a marked response to gabapentin; seven, a moderate response; two, mild; and two, no response to treatment. Six patients discontinued treatment due to somatic complaints (i.e., sedation or fatigue). The most frequently reported adverse effect was sedation. Limitations: Gabapentin was added openly, and rating was nonblind in this case series. The use of concomitant medications could have increased the amount of sedation experienced with gabapentin. Conclusion: Overall, gabapentin was associated with moderate improvement of mood symptoms. Given the severity and chronicity of these patients' illness, a moderate response must be considered a relative success. Controlled studies of gabapentin are needed to clarify its role in the treatment of bipolar disorder.
The journal of the American Academy of Psychiatry and the Law, 2015