Faculty Bibliography

This discussion focuses on three basic areas relevant to tardive dyskinesia (TD). The first area includes an overview of some specific acts of negligence that have been the basis for successful malpractice cases involving TD. Some of these acts of negligence include inappropriate assessment of the patient, failure to properly care for TD, and failure to obtain a proper informed consent. The second area involves the problems of uncertainty, which are particularly manifested where the only treatment available has a high benefit but a low risk of serious adverse effects. The uncertainty rests on the limited information regarding detection of the serious consequences, or cure, once the full-blown condition develops. The third involves exploring alternatives to the tort system, such as an automatic system of compensation, which might be more appropriate for dealing with an outcome such as TD. Alternative systems might be more effective in combining incentives for quality care with adequate compensation for the injured where the condition might have been avoided

Brain function was evaluated in four psychiatric patients with a history of repetitive purposeless violent behaviour, using EEG, CT scan, and positron emission tomography (PET). Three patients showed spiking activity in left temporal regions, and two showed CT scan abnormalities characterised by generalised cortical atrophy. The PET scans for the four cases showed evidence of blood flow and metabolic abnormalities in the left temporal lobe. Two patients also had derangement in the frontal cortex. The patients showing the largest defects with the PET scans were those whose CT scans were reported as normal. This paper shows the utility of PET in investigating possible brain derangements that could lead to violent behaviour