J A Silva

Publications of J A Silva

• Delusional misidentification and aggression in Alzheimer's disease.

  Authors: J A Silva, G B Leong, R Weinstock, M Ruiz-Sweeney

  Journal of forensic sciences. 06/2001; 46(3):581-5.

  Alzheimer's disease has been associated with serious behavioral disturbances including aggressive behaviors and agitation. Aggression in dementia of the Alzheimer's type may be associated withAlzheimer's disease has been associated with serious behavioral disturbances including aggressive behaviors and agitation. Aggression in dementia of the Alzheimer's type may be associated with psychotic symptoms, particularly delusional misidentification phenomena. These phenomena are complex and varied in Alzheimer's disease and so far have been only rudimentarily described. In this paper, we explore the association of delusional misidentification and aggression in an individual suffering from Alzheimer's disease.

• A classification of psychological factors leading to violent behavior in posttraumatic stress disorder.

  Authors: J A Silva, D V Derecho, G B Leong, R Weinstock, M M Ferrari

  Journal of forensic sciences. 04/2001; 46(2):309-16.

  Posttraumatic stress disorder has long been linked to violent behavior. However, the exact nature of that association remains poorly characterized due to the limitations of knowledge in the area ofPosttraumatic stress disorder has long been linked to violent behavior. However, the exact nature of that association remains poorly characterized due to the limitations of knowledge in the area of phenomenology, contextual factors, the biology, and the nature of the aggression involved in the disorder. A clear understanding of the genesis of violence in posttraumatic stress disorder can be helpful to those involved in assessing psychiatric-legal issues relevant to the disorder and in its therapeutic management. In this article, we review the potential psychological links between posttraumatic stress disorder secondary to combat exposure and violent behavior and suggest a tentative classification of the main psychological causes of violence in that syndrome.

• Sexually violent predator II: the sequel.

  Authors: G B Leong, J A Silva

  The journal of the American Academy of Psychiatry and the Law. 02/2001; 29(3):340-3.

• Potential erosion of psychotherapist-patient privilege beyond California: dangers of "criminalizing" Tarasoff.

  Authors: R Weinstock, G B Leong, J A Silva

  Behavioral sciences & the law. 02/2001; 19(3):437-49.

  The "dangerous patient exception" to psychotherapist-patient privilege, adopted almost a decade before the celebrated case of Tarasoff v. Regents of the University of California (1976), was mentionedThe "dangerous patient exception" to psychotherapist-patient privilege, adopted almost a decade before the celebrated case of Tarasoff v. Regents of the University of California (1976), was mentioned in a footnote to that decision in the context of an analogy. Although intended to permit testimony in civil commitment proceedings, this exception has been used to "criminalize" the Tarasoff duty in California. California courts eroded the privilege initially primarily to permit victims to sue psychotherapists and later to require psychotherapists to testify against their patients in criminal proceedings and appear to have confused evidentiary privilege and confidentiality. If consistent, similar reasoning in California in the future should allow therapists to testify against their patients if they were civilly committed in the past for dangerousness and attorneys to testify against their clients in criminal cases if at some earlier time they believed their clients represented a risk of future harm. Although most other jurisdictions may not word their privilege exceptions for civil commitment in the same way as California, most states have some type of privilege exception for civil commitment that could allow for such an interpretation. The United States Supreme Court in Jaffee v. Redmond (1996) found a psychotherapist-patient privilege, but stated in a footnote that an exception to the privilege would exist if a serious threat of harm to the patient could be averted only by means of disclosure by the therapist. Other jurisdictions have begun to consider these issues. Rather than being unique to California, similar reasoning could lead to the "criminalization" of Tarasoff in other jurisdictions and thereby compel therapists outside California to testify against their patients in criminal proceedings.

• Regional metabolic effects of fluoxetine in major depression: serial changes and relationship to clinical response.

  Authors: H S Mayberg, S K Brannan, J L Tekell, J A Silva, R K Mahurin, S McGinnis, P A Jerabek

  Biological psychiatry. 11/2000; 48(8):830-43.

  BACKGROUND: Treatment of major depression with antidepressants is generally associated with a delay in onset of clinical response. Functional brain correlates of this phenomenon have not beenBACKGROUND: Treatment of major depression with antidepressants is generally associated with a delay in onset of clinical response. Functional brain correlates of this phenomenon have not been previously characterized. METHODS: Time course of changes in brain glucose metabolism were measured using positron emission tomography in hospitalized unipolar depressed patients treated with fluoxetine. Time-specific and response-specific effects were examined at 1 and 6 weeks of treatment. RESULTS: Changes were seen over time, and characterized by three distinct patterns: 1) common changes at 1 and 6 weeks, 2) reversal of the 1-week pattern at 6 weeks, and 3) unique changes seen only after chronic treatment. Fluoxetine responders and nonresponders, similar at 1 week, were differentiated by their 6-week pattern. Clinical improvement was uniquely associated with limbic and striatal decreases (subgenual cingulate, hippocampus, insula, and pallidum) and brain stem and dorsal cortical increases (prefrontal, parietal, anterior, and posterior cingulate). Failed response was associated with a persistent 1-week pattern and absence of either subgenual cingulate or prefrontal changes. CONCLUSIONS: Chronic treatment and clinical response to fluoxetine was associated with a reciprocal pattern of subcortical and limbic decreases and cortical increases. Reversal in the week-1 pattern at 6 weeks suggests a process of adaptation in specific brain regions over time in response to sustained serotonin reuptake inhibition. The inverse patterns in responders and nonresponders also suggests that failure to induce these adaptive changes may underlie treatment nonresponse.

• Capgras syndrome during the wake and dream state.

  Authors: J A Silva, G B Leong

  Canadian journal of psychiatry. Revue canadienne de psychiatrie. 05/2000; 45(3):299-300.

• Evaluation of competence to consent to assisted suicide: views of forensic psychiatrists.

  Authors: L Ganzini, G B Leong, D S Fenn, J A Silva, R Weinstock

  The American journal of psychiatry. 05/2000; 157(4):595-600.

  OBJECTIVE: Mental health evaluation of competence to consent has been proposed as an important safeguard for patients requesting assisted suicide, yet mental health professionals have not developedOBJECTIVE: Mental health evaluation of competence to consent has been proposed as an important safeguard for patients requesting assisted suicide, yet mental health professionals have not developed guidelines or standards to aid in such evaluations. The authors surveyed a national sample of forensic psychiatrists in the United States regarding the process, thresholds, and standards that should be used to determine competence to consent to assisted suicide. METHOD: An anonymous questionnaire was sent to board-certified forensic psychiatrists between August and October 1997. RESULTS: Of the 456 forensic psychiatrists who were sent the questionnaire, 290 (64%) responded. Sixty-six percent believed that assisted suicide was ethical in at least some circumstances, and 63% thought that it should be legalized for some competent persons. Twenty-four percent indicated that it was unethical for psychiatrists to determine competence; however, 61% thought such an evaluation should be required in some or all cases. Seventy-eight percent recommended a very stringent standard of competence. Seventy-three percent believed that at least two independent examiners were needed to determine competence, and 44% favored requiring judicial review of a decision. Fifty-eight percent believed that the presence of major depressive disorder should result in an automatic finding of incompetence. Psychiatrists with ethical objections to assisted suicide advocated a higher threshold for competence and more extensive review of a decision. CONCLUSIONS: The ethical views of psychiatrists may influence their clinical opinions regarding patient competence to consent to assisted suicide. The extensive evaluation recommended by forensic psychiatrists would likely both minimize this bias and assure that only competent patients have access to assisted suicide, but the process might burden terminally ill patients.

• A case of partial lycanthropy.

  Authors: J A Silva, D V Derecho, G B Leong

  Canadian journal of psychiatry. Revue canadienne de psychiatrie. 04/2000; 45(2):201-2.

• A case of Cotard's syndrome associated with self-starvation.

  Authors: J A Silva, G B Leong, R Weinstock, C L Gonzales

  Journal of forensic sciences. 02/2000; 45(1):188-90.

  Cotard's syndrome is a psychotic condition often associated with nihilistic delusions. This syndrome can be associated with destructive behaviors directed at the self and/or others. In this report weCotard's syndrome is a psychotic condition often associated with nihilistic delusions. This syndrome can be associated with destructive behaviors directed at the self and/or others. In this report we highlight the psychiatric-legal issues involving a case of Cotard's syndrome associated with self-starvation.

• Stalking behavior in delusional jealousy.

  Authors: J A Silva, D V Derecho, G B Leong, M M Ferrari

  Journal of forensic sciences. 02/2000; 45(1):77-82.

  Stalking behavior has been associated with several mental disorders, both psychotic and non-psychotic. The most frequently associated condition appears to be an individual with primitive personalityStalking behavior has been associated with several mental disorders, both psychotic and non-psychotic. The most frequently associated condition appears to be an individual with primitive personality psychopathology regardless of co-occurring psychotic symptomatology. Among the psychotic symptoms, erotomanic, and jealousy delusions may be the most clinically and torensically relevant. However, delusional jealousy has not been well appreciated in the psychiatric literature as an important contributor to stalking behavior. In this article, we explore the psychiatric, psychosocial, and forensic aspects of stalking in the context of delusional jealousy. We use a case example to highlight important issues in this area.

• Survey of forensic psychiatrists on evaluation and treatment of prisoners on death row.

  Authors: G B Leong, J A Silva, R Weinstock, L Ganzini

  The journal of the American Academy of Psychiatry and the Law. 02/2000; 28(4):427-32.

  Psychiatrists have debated their role in evaluating prisoners accused of capital crimes and in treating prisoners on death row when restoration of competence would result in execution. DespitePsychiatrists have debated their role in evaluating prisoners accused of capital crimes and in treating prisoners on death row when restoration of competence would result in execution. Despite debate, there are no previous surveys of psychiatrists' opinions on this issue. We sent an anonymous questionnaire to all board-certified forensic psychiatrists in the United States. Of the 456 forensic psychiatrists identified, 290 (64%) returned the survey. Most respondents supported a role, in at least some cases, for psychiatric evaluation of prisoners accused of capital crimes. Respondents were divided on whether or not psychiatrists should treat incompetent death row prisoners if restoration of competence would result in execution. Attitudes about the ethical acceptability of capital punishment were associated with views about the psychiatrists' role but were not determinative in every case.

• Revisiting arson from an outpatient forensic perspective.

  Authors: G B Leong, J A Silva

  Journal of forensic sciences. 06/1999; 44(3):558-63.

  Progress in the understanding of individuals who commit arson has been on a slow but steady course over the past two decades. From our review of court-ordered outpatient forensic psychiatricProgress in the understanding of individuals who commit arson has been on a slow but steady course over the past two decades. From our review of court-ordered outpatient forensic psychiatric evaluation of individuals charged with arson over a five-year period, preliminary prototypical profiles of the psychotic, mentally retarded, alcohol abusing, and mood-disordered firesetter are offered. The clinical-legal relevance of our results are explored.

• Reciprocal limbic-cortical function and negative mood: converging PET findings in depression and normal sadness.

  Authors: H S Mayberg, M Liotti, S K Brannan, S McGinnis, R K Mahurin, P A Jerabek, J A Silva, J L Tekell, C C Martin, J L Lancaster, P T Fox

  The American journal of psychiatry. 06/1999; 156(5):675-82.

  OBJECTIVE: Theories of human behavior from Plato to Freud have repeatedly emphasized links between emotion and reason, a relationship now commonly attributed to pathways connecting phylogeneticallyOBJECTIVE: Theories of human behavior from Plato to Freud have repeatedly emphasized links between emotion and reason, a relationship now commonly attributed to pathways connecting phylogenetically "old" and "new" brain regions. Expanding on this theory, this study examined functional interactions between specific limbic and neocortical regions accompanying normal and disease-associated shifts in negative mood state. METHOD: Regions of concordant functional change accompanying provocation of transient sadness in healthy volunteers and resolution of chronic dysphoric symptoms in depressed patients were examined with two positron emission tomography techniques: [15O]water and [18F]fluorodeoxyglucose, respectively. RESULTS: With sadness, increases in limbic-paralimbic blood flow (subgenual cingulate, anterior insula) and decreases in neocortical regions (right dorsolateral prefrontal, inferior parietal) were identified. With recovery from depression, the reverse pattern, involving the same regions, was seen--limbic metabolic decreases and neocortical increases. A significant inverse correlation between subgenual cingulate and right dorsolateral prefrontal activity was also demonstrated in both conditions. CONCLUSIONS: Reciprocal changes involving subgenual cingulate and right prefrontal cortex occur with both transient and chronic changes in negative mood. The presence and maintenance of functional reciprocity between these regions with shifts in mood in either direction suggests that these regional interactions are obligatory and probably mediate the well-recognized relationships between mood and attention seen in both normal and pathological conditions. The bidirectional nature of this limbic-cortical reciprocity provides additional evidence of potential mechanisms mediating cognitive ("top-down"), pharmacological (mixed), and surgical ("bottom-up") treatments of mood disorders such as depression.

• Dangerous misidentification of people due to flashback phenomena in posttraumatic stress disorder.

  Authors: J A Silva, G B Leong, B E Harry, J Ronan, R Weinstock

  Journal of forensic sciences. 12/1998; 43(6):1107-11.

  Misidentification of people may occur in a number of psychiatric disorders associated with delusional thinking. Misidentification of people may also occur in the context of visual flashback phenomenaMisidentification of people may occur in a number of psychiatric disorders associated with delusional thinking. Misidentification of people may also occur in the context of visual flashback phenomena associated with post-traumatic stress disorder. People who misidentify someone during a flashback associated with previous war combat experience may perceive and conceptualize the misidentified object as an enemy who may be both feared and disliked. This might make the misidentified objects become the targets of violent attacks by the affected person. In this article we present five cases of flashback-induced misidentification of people who were subsequently attacked within the context of the flashback experience. The nature of the misidentification of persons due to flashback experiences is discussed. The association between the type of misidentification and aggression is also discussed.

• A comprehensive typology for the biopsychosociocultural evaluation of child-killing behavior.

  Authors: J A Silva, G B Leong, A Dassori, M M Ferrari, R Weinstock, J Yamamoto

  Journal of forensic sciences. 12/1998; 43(6):1112-8.

  The homicide of children by their parents has been reported across numerous cultural settings around the world and in many historical periods. A comprehensive and systematic understanding of parentalThe homicide of children by their parents has been reported across numerous cultural settings around the world and in many historical periods. A comprehensive and systematic understanding of parental child killing can be optimally obtained through a biopsychosociocultural approach. In this article we present the case of a woman who committed neonaticide. We illustrate the cultural formulation of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and recommend that this formulation has a central role in the evaluation of cultural factors of parents who kill their children.

• Delusion of sexual transformation as delusional misidentification syndrome.

  Authors: J A Silva, G B Leong, G Penny

  Canadian journal of psychiatry. Revue canadienne de psychiatrie. 12/1998; 43(9):956-7.

• Delusional physical misidentification in the syndrome of subjective doubles.

  Authors: A R Jones, J A Silva, G B Leong

  Canadian journal of psychiatry. Revue canadienne de psychiatrie. 05/1998; 43(3):308.

• Erotomania in a case of fragile-X syndrome.

  Authors: J A Silva, M M Ferrari, G B Leong

  General hospital psychiatry. 04/1998; 20(2):126-7.

• Violent behaviors associated with the antichrist delusion.

  Authors: J A Silva, G B Leong, R Weinstock

  Journal of forensic sciences. 12/1997; 42(6):1058-61.

  Delusions involving the antichrist concept have been occasionally reported. Some cases of the antichrist delusion have been associated with violent behavior. In this article we describe the case of aDelusions involving the antichrist concept have been occasionally reported. Some cases of the antichrist delusion have been associated with violent behavior. In this article we describe the case of a man who suffered from a chronic antichrist delusion and who also displayed repeated and serious violent behaviors. We also discuss the role of the antichrist delusion as well as other psychotic symptoms in the genesis of violence in the present case.

• The "delirium" of delusional misidentification: implications for the classification of delusional misidentification syndromes.

  Authors: J A Silva, G B Leong

  Canadian journal of psychiatry. Revue canadienne de psychiatrie. 09/1997; 42(6):665.