Dr. Lorandos Interviewed on Larry King Live
 
 
About The Author

Demosthenes Lorandos is an attorney, forensic psychologist, lecturer and author.  He is in constant demand across the country for his authoritative and tireless advocacy on behalf of the falsely accused.   In defense of his clients Dr. Lorandos brings to bear his extensive expertise in the science of coerced confessions, shaken baby syndrome, battered women’s syndrome, parental alienation syndrome, recovered memories, false accusations, repeated question effects, interviewer bias, behavioral indicators of abuse and other related subjects.  Dr. Lorandos is a member of the California, Michigan, New York, Tennessee and Washington, D.C. bars, and a member of the bar of the United States Supreme Court.   He is also the co-author of such works as Cross Examining Experts in the Behavioral Sciences, Benchbook in the Behavioral Sciences and The International Handbook of Parental Alienation Syndrome. Dr. Lorandos may be recognizeable from his appearances on The Today Show, The View, Larry King Live and Court TV, and from his extensive online catalog of free legal advice videos.

 
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Stressful Life Events and Other Risk Factors
Posted On October 8th, 2012  By admin    

In the six months before a suicide attempt, patients report four times as many stressful life events compared to the general population.[1]  Assessing the potential impact of stressful life events necessitates reviewing recent experiences of interpersonal loss (e.g., loss of a close friend or relative, loss of a relationship, loss of job, etc.)  Consistent with the “Why now?” question we at Falsely-Accused.net discussed in prior posts, contemporary stressors exercise a greater influence on suicidal risk than more remote events. 

Diagnostic status is also related to suicide risk.  The broad class of mood disorders, substance abuse, schizophrenia, organic brain syndromes, and personality disorders are all associated with elevated suicide risk.[2]  Social support and expressed emotion significantly influence prognosis for the mood disorders and schizophrenia. [See prior posts in this section]  Correspondingly, social support and expressed emotion significantly influence suicide risk.  We at Falsely-Accused.net believe that rigid thinking and impulsivity interfere with problem‑solving efficiency; and in turn, contribute to feelings of hopelessness.  Rigid thinking and impulsivity also increase the risk of suicide.[3]

Other factors related to suicide risk include gender, age, living alone, unemployment, and health status.[4]  Females attempt suicide three times more frequently than males, but males actually commit suicide three times more frequently than females.  We at Falsely-Accused.net feel that consequently, we can infer that males at risk for suicide are more likely to present the “resolved plans and preparation” factor.  The frequency with which females attempt suicide also increases the risk of completed suicide via accidental mishaps (e.g., while standing on a chair with a noose around her neck contemplating suicide, the victim accidentally falls).

The ratio of attempted suicide to completed suicide is approximately 7:1 for the adult population under age 65.  For the population over age 65, this ratio is 2:1.  Living alone obviously diminishes the level of social support.  Unemployment also reduces social support, and increases feelings of hopelessness.  Chronic illnesses also contribute to feelings of hopelessness.  Combined together, careful assessment of suicidality places a client on a risk continuum of (1) non‑existent risk, (2) mild risk, (3) moderate risk, (4) severe risk, and (5) extreme risk.

Cross‑Examining Stressful Life Events and Other Risk Factors

1.  Diagnostic groups such as mood disorders, substance abuse, schizophrenia, organic brain syndrome, and personality disorders all present heightened suicide risks ‑‑ Correct?

2.  So, diagnostic status is related to suicide risk ‑‑ Correct?

3.  In this case did you consider the client’s diagnostic status when assessing suicide risk?

4.  Did you document your consideration of the client’s diagnostic status when assessing suicide risk?

[If the witness says “yes” - confront and ask to see the documentation]

5.  Rigidity in thinking also increases suicide risk ‑‑ Correct?

6.  In this case, did you assess the rigidity of the client’s thinking when addressing suicide risk?

[If the witness says “yes” - confront and ask to see the documentation]

7.  Did you document your assessment of the client’s rigid thinking in the course of addressing suicide risk?

8.  Females attempt suicide significantly more often than males ‑‑ Correct?

9.  But males actually commit suicide significantly more often then females ‑‑ Correct?

10.  And as a result of accidental mishaps with unintended consequences, the greater frequency with which females attempt suicide also puts them at risk ‑‑ Correct?

11.  In this case did you consider gender when assessing the client’s suicide risk?

12.  Did you document your consideration of gender when assessing the client’s suicide risk?

[If the witness says “yes” - confront and ask to see the documentation]

13.  Age is also a factor regarding suicide risk ‑‑ Correct?

14.  In this case, did you consider the client’s age when assessing suicide risk?

15.  Did you document your considering the client’s age when assessing suicide risk?

[If the witness says “yes” - confront and ask to see the documentation]

16.  Combining consideration of the relevant risk factors would allow you to assess suicide risk along a continuum ‑‑ Correct?

17.  And that continuum might range from non‑existent risk, to mild risk, to moderate risk, to severe risk, and to extreme risk ‑‑ Correct?

18.  Using this continuum, what level of risk did assign to the client in this case?

19.  Did you document the level of risk you assigned to the client in this case?

[If the witness says “yes” - confront and ask to see the documentation]

Hospitalization

In cases of severe and extreme suicidal risk, hospitalization is typically necessary.  Excessively brief hospitalizations, however, are ill‑advised and may be counterproductive. We at Falsely-Accused.net find that in particular, generally recognized and accepted opinion has indicated the following regarding suicidal patients:

“When inpatient treatment is necessary, it becomes vital to allow an adequate length of stay.  Very brief hospitalizations (i.e., less than seven days) are unlikely to be effective and may be detrimental when the patient is suddenly discharged back to a home environment filled with conflict and loss.  Returning a suicidal patient to the same social environment that precipitated the suicide attempt can be dangerous.”[5]

In particular, very brief hospitalizations are insufficient for addressing issues of social support and expressed emotion in the patient’s home environment. [See prior posts in this section]  During hospitalization, it is also imperative for treatment personnel to communicate with family members.[6]  Without such communication, family members can retreat from the patient because of their uncertainty regarding what they should, and should not, do.  Suicidal patients can mistakenly interpret these familial retreats as evidence of rejection.

Consulting with the patient’s family is especially imperative when considering discharge from an in‑patient facility.[7]  A well‑defined crisis plan, clearly understood by both patient and family, is necessary for protecting the patient’s welfare in the more unstructured home setting.  We at Falsely-Accused.net believe that a crisis plan should inform patient and family of phone numbers for crisis purposes, encourage seeking services early in a crisis, and detail the procedures for emergency admission to an in‑patient facility.[8]

Cross‑Examining Issues Regarding Hospitalization

[USE THE 22 FOUNDATIONAL QUESTIONS FROM PREVIOUS POSTS IF YOU HAVE NOT YET DONE SO]

1.  The journal Behavioral Sciences and the Law is a generally recognized and accepted, peer‑reviewed journal in your field ‑‑ Correct?

2.  And a 1995 article by Overholser published in Behavioral Sciences and the Law ‑ titled “Treatment of Suicidal Patients: A Risk‑Benefit Analysis” ‑ might be relevant to your opinions in this case ‑‑ Correct?

3.  Please consider Overholser’s comments from his 1995 article:

- [ read ] -

“When inpatient treatment is necessary, it becomes vital to allow an adequate length of stay.  Very brief hospitalizations (i.e., less than seven days) are unlikely to be effective and may be detrimental when the patient is suddenly discharged back to a home environment filled with conflict and loss.  Returning a suicidal patient to the same social environment that precipitated the suicide attempt can be dangerous.”

Now my question: If very brief hospitalizations can be dangerous, was this factor considered when the patient in this case was discharged?

4.  Were considerations of the problems associated with brief hospitalization documented in this case?

[If the witness says “yes” - confront and ask to see the documentation]

5.  Very brief hospitalizations are insufficient for addressing issues of social support and expressed emotion in the patient’s home environment ‑‑ Correct?

6.  Were issues of social support and expressed emotion considered at the time of the patient’s discharge in this case?

[If the witness says “yes” - confront and ask to see the documentation]

7.  Is there documentation demonstrating that the issues of social support and expressed emotion were considered at discharge?

8.  During hospitalization, it is also important for treatment personnel to communicate with family members ‑‑ Correct?

9.  Without such communication, family members can retreat from the patient because of their uncertainty regarding what they should, and should not, do ‑‑ Correct?

10.  And suicidal patients can mistakenly interpret these familial retreats as evidence of rejection ‑‑ Correct?

11.  Was the necessity for family communication documented in the hospital’s treatment plan?

[If the witness says “yes” - confront and ask to see the documentation]

12.  Is there documentation of treatment personnel actually communicating substantive information to the patient’s family?

13.  Consulting with the patient’s family is especially imperative when considering discharge from an in‑patient facility ‑‑ Correct?

14.  And a well‑defined crisis plan, clearly understood by both patient and family, is necessary for protecting the patient’s welfare at discharge ‑‑ Correct?

15.  A well‑defined crisis plan should inform patient and family of phone numbers for crisis purposes ‑‑ Correct?

16.  And a well‑defined crisis plan should encourage seeking services early in a crisis ‑‑ Correct?

17.  And a well‑defined crisis plan should detail the procedures for emergency admission to an in‑patient facility ‑‑ Correct?

18.  In this case did the hospital develop a well‑defined crisis plan prior to the patient’s discharge?

[If the witness says “yes” - confront and ask to see the documentation]

19.  Is there any documentation in the patient’s chart verifying the development of a well‑defined crisis plan in this case?

[If the witness says “yes” - confront and ask to see the documentation]


[1].  Paykel, E.S., Prusoff, B.A. & Myers, J.K. (1975). Suicide attempts and recent life events: A controlled comparison. Archives of General Psychiatry, 32, 327‑333.

[2].  Joiner, T.E., Walker, R.L., Rudd, M.D. & Jobes, D.A. (1999). Scientizing and routinizing the assessment of suicidality in outpatient practice. Professional Psychology: Research and Practice, 30, 447‑453.               

[3].  Id.

[4].  Pope, K.S. & Vasquez, M.J.T. (1998). Assessment of suicidal risk. In G.P. Koocher, J.C. Norcross & S.S. Hill (Eds), Psychologists desk reference. New York: Oxford U. Press.

[5].  Overholser, J.C. (1995). Treatment of suicidal patients: A risk‑benefit analysis. Behavioral Sciences and the Law, 13, 81‑92. (p. 87).

[6].  Bongar, B., Peterson, L., Harris, E. & Aissis, J. (1989). Clinical and legal considerations in the management of suicidal patients: An integrative review. Journal of Integrative and Eclectic Psychotherapy, 8, 53‑67.

[7].  Bongar, B., Maris, R., Berman, A., Litman, R. & Silverman, M. (1993). Inpatient standards of care and the suicidal patient. Part I: General clinical formulations and legal considerations. Suicide & Life‑Threatening Behavior, 23, 245‑256.

[8].  Morgan, H., Jones, E. & Owen, J. (1993). Secondary prevention of non‑fatal deliberate self‑harm: The green card study. British Journal of Psychiatry, 163, 111‑112.

 

 
 
 
 
 
By Gardner, Sauber, and Lorandos, has become the standard reference work for PAS. The International Handbook features clinical, legal, and research perspectives from 32 contributors from eight countries.
 
The International Handbook of
Parental Alienation Syndrome
 
By Terrence W. Campbell and Demosthenes Lorandos, is a must for every family law practitioner. This two-volume practice set provides step-by-step guidance how to refute behavioral scientists.
 
Cross Examining Experts in the
Behavioral Sciences
 
By Lorandos and Campbell, provides immediate access to authoritative information and immediate decision-making tools for judges and attorneys.
 
Benchbook in the Behavioral Sciences