Ruff Ronald
Department of Psychiatry, University of California San Francisco, San Francisco, San Francisco, CA 94109, USA.
J Head Trauma Rehabil. 2009 Mar-Apr;24(2):131-40. doi: 10.1097/01.HTR.0000348755.42649.e9.
Forensic examiners generally agree that their contributions to the forensic process have to be based on scientific principles, high ethical values, and sound clinical skills and judgment. In part I, the challenges of maintaining high ethical standards as a scientist-practitioner are addressed. In part II, the scientific strengths and weaknesses of our neuropsychological assessments are explored within the context of the 4 articles published in this issue. Specifically, Wood points out that while most traumatic brain injuries (TBIs) compromise the prefrontal cortex (PFC), traditional neuropsychological examinations do not fully capture to what extent PFC damage disrupts cognitive, emotional, and social regulation. New advances in clinical neuroscience are presented to facilitate a more detailed understanding of PFC functioning. Schwarz et al examine how clinical neuropsychology services can adequately handle forensic consultations. Frederick and Bowden, meanwhile, identify the persistent weaknesses of various Symptom Validity Tests in reliably classifying poor effort and malingering. Bailey et al conclude that the findings from sport concussion studies cannot be generalized to clinical populations, who, as a rule, have more premorbid and comorbid vulnerabilities. Finally, part III provides guidelines based on the introductory article by Bigler and Brooks, as well as a synopsis of the main conclusions offered by the contributors in this journal issue. Guidelines for both the diagnosis of mild TBI and the diagnosis of postconcussional disorder are included.
法医鉴定人员普遍认为,他们对法医程序的贡献必须基于科学原则、高度的道德价值观以及扎实的临床技能和判断力。在第一部分中,探讨了作为科学家 - 从业者维持高道德标准所面临的挑战。在第二部分中,结合本期发表的4篇文章,探讨了我们神经心理学评估的科学优势与不足。具体而言,伍德指出,虽然大多数创伤性脑损伤(TBI)会损害前额叶皮质(PFC),但传统的神经心理学检查并未充分捕捉到PFC损伤在多大程度上破坏认知、情绪和社会调节功能。文中介绍了临床神经科学的新进展,以促进对PFC功能的更详细理解。施瓦茨等人研究了临床神经心理学服务如何充分处理法医咨询。与此同时,弗雷德里克和鲍登指出了各种症状效度测试在可靠区分努力程度不足和伪装方面持续存在的弱点。贝利等人得出结论,运动性脑震荡研究的结果不能推广到临床人群,因为临床人群通常有更多病前和共病的易感性。最后,第三部分根据比格勒和布鲁克斯的介绍性文章提供了指导方针,以及本期刊物撰稿人提出的主要结论概要。其中包括轻度TBI诊断和脑震荡后障碍诊断的指导方针。