eMedicine Specialties > Psychiatry > Adult

Psychiatric Illness Associated With Criminality

Author: Michael Menaster, MD, MA, General and Forensic Psychiatrist, Private Practice
Contributor Information and Disclosures

Updated: Jul 7, 2008

Introduction

Like the term insanity, criminality is a legal term and is specifically not a medical or psychiatric term, diagnosis, illness, or syndrome. Webster's dictionary defines criminality as "the quality or state of being a criminal; criminal activity." Webster's further defines a criminal as "relating to, involving, or being a crime; relating to crime or to the prosecution of suspects in a crime; guilty of crime; also: of or befitting a criminal; disgraceful." In other words, the term refers to a pattern of human behavior or a specific act violating a law.

Criminality usually involves intent to commit a wrong or serious negligence; individuals who lack criminal intent or negligence, such as infants, are usually not convicted of crimes. While this exoneration appears unfair, the purposes of the law are to deter and punish criminal behavior, neither of which would be accomplished by punishing those without criminal intent or serious negligence. Further complicating matters is mental illness, which is frequently associated with criminality. Mental illness can also occasionally be a tenable defense against criminality (eg, the insanity defense). Society would not benefit from punishing individuals who cannot be held responsible for their behavior (an exception exists for serious negligence, such as manslaughter resulting from an individual’s driving under the influence of alcohol or drugs).

Different societies frequently have different customs, philosophies, and standards of behaviors, all of which impact their laws and criminal justice system. Accordingly, criminality is relative to society; individuals in one society may be treated as criminals, while the same individuals in another society would not be treated as such. Further complicating matters, police, courts, and governments have flexibility with enforcing laws, which determines who should be prosecuted as a criminal. For example, some societies are so intolerant of diversity that they treat political dissidents as criminals.

Because criminality is a legal issue that is relative to a particular society, no surgical, medical, or psychiatric interventions can treat it per se. However, mental illness can result in symptoms associated with criminal activity and sometimes actual criminal activity. Because those symptoms may be treatable, in a sense, criminality could be treated.

Nearly any psychiatric symptom can be associated with criminality, because symptoms can impair judgment and directly or indirectly violate societal norms. For example, an individual with major depression and insomnia may fall asleep while driving and kill a pedestrian, resulting in a manslaughter conviction. Frequent psychiatric conditions associated with criminality are listed below. Incarceration itself is distressing and can be associated with the onset or exacerbation of psychiatric disorders.

However, most individuals with mental illness are not violent.1 In fact, a study of individuals with psychotic disorders found that those with a mental illness were responsible for only 5% of all violent crimes.2 An exception to this rule involves sexual offenders, who had high rates of substance use disorders, paraphilias, mood disorders, impulse control disorders, anxiety disorders, eating disorders, and antisocial personality disorders.3 Other exceptions include antisocial personality disorder and substance abuse.4

The eMedicine journal has further information on these disorders. Please click on the following hyperlinks for further information.

Psychiatric diagnoses commonly associated with criminality

Anxiety disorders

Delirium

Delusional disorder

Dementias

Impulse control disorders

Intoxication or withdrawal from medications or drugs

Malingering

Mood disorders

Personality disorders, especially antisocial personality disorder

Pervasive developmental disorder (autism)

Psychotic disorder, not otherwise specified

Schizoaffective disorder

Schizophrenia

Schizophreniform disorder

Substance dependence and abuse

Traumatic brain injury

These psychiatric disorders comprise the principal psychiatric illnesses found in individuals involved with the criminal justice system. Disorders defined by behaviors more directly linked to criminality include antisocial personality disorder, impulse control disorders (eg, intermittent explosive disorder, kleptomania, pyromania, pathological gambling), and paraphilias (eg, voyeurism, exhibitionism, frotteurism, pedophilia).

However, individuals with these illnesses are not criminals by virtue of having the disorder. Rather, such disorders are considered more closely linked to criminality, because the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria for diagnosing these disorders include symptoms that tend to violate the rights of others.

See related Medscape Resource Centers, Addiction, Anxiety Disorders, and Schizophrenia.

Epidemiology

Substance Abuse

Substance abuse dramatically increases the risk of criminal behavior, particularly violence. Individuals who abuse alcohol or drugs have a higher lifetime prevalence of arrests than individuals with schizophrenia, personality disorders, or mood disorders.5 Women with antisocial personality disorder who are alcohol dependent have 40-50 times higher rates of homicide than the general population.6 Compared with individuals who are mentally ill without substance abuse, dual diagnosis individuals are 240% more likely to engage in violence. A history of alcohol abuse is the strongest predictor of domestic violence and elder abuse.7 Chronic alcohol dependence is more predictive of violence than acute alcohol use.8 In addition, intoxication or withdrawal is highly associated with violence.9

Antisocial personality disorder

The estimated prevalence of antisocial personality disorder in the general population is 3% of males and less than 1% of females. It is more prevalent in impoverished, urban areas. By definition, individuals with antisocial personality disorder must be at least 18 years of age. Antisocial personality disorder is highly associated with violence.4 It is also strongly associated with incarceration. In a meta-analysis, 47% of prison inmates were diagnosed with antisocial personality disorder.10

Impulse control disorders

Kleptomania: Few studies have been published on this relatively rare condition, the prevalence of which is 0.6%. Accordingly, fewer than 5% of shoplifters meet the criteria for this disorder. Typically, several decades pass between the onset of thefts and an individual's presentation for treatment, usually in the context of involvement with the criminal justice system. Women are more likely than men to be diagnosed with kleptomania. Women with this disorder enter treatment in the fourth decade of life, men in their sixth decade.

Pyromania: This disorder is rare, occurring more frequently in males than in females. It is often associated with a history of fascination with fire, dating back to childhood or early adolescence. Ninety percent of arsonists have documented psychiatric histories; 36% of those individuals had schizophrenia or bipolar disorder, while 64% were using alcohol or drugs during their fire-setting activity. A few reports note an association between fire-setting and epilepsy. However, pyromania was diagnosed only in 3 of 283 cases. Motives vary from anger to delusions.

Pathological gambling: Estimated incidence in the general population is 3%. Cultural and sociological factors play a role in the specific manifestation of behavior (eg, horseracing, cockfights, ma jong, pai gow, the stock market, lotteries, bingo). Curiously, although 30% of individuals with this condition are females, women constitute only 2-4% of Gamblers Anonymous membership.

Intermittent explosive disorder: Although episodic violence is common in the United States, according to strict diagnostic criteria, this disorder is rare. Males constitute 80% of the people with this disorder.

Paraphilias: More than 90% of people with this disorder are male. In more than 50% of people with the disorder, onset of paraphilic arousal occurs when they are younger than 18 years.

Clinical Features

Antisocial personality disorder

The course of antisocial personality disorder is variable. Generally, the course improves with age. Many become incarcerated, develop comorbid substance abuse or dependency, and incur injuries and violent deaths.

According to the DSM-IV-TR, diagnostic criteria for antisocial personality disorder are as follows: 

  • A history of conduct disorder must have existed with an onset prior to age 16. Unlike most personality disorders, individuals must be at least 18 years of age. They demonstrate a pervasive pattern of deception and disregard for and violation of the rights of others, as indicated by at least 3 of the following:
    • Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest
    • Deceitfulness, as indicated by repeated lying, use of aliases, or conning (swindle by persuasion) others for personal profit or pleasure
    • Impulsivity or failure to plan ahead
    • Irritability and aggressiveness, as indicated by repeated physical fights or assaults
    • Reckless disregard for safety of self or others
    • Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
    • Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another

Impulse control disorders

According to the DSM-IV-TR, the criteria for impulse control disorders are as follows:

  • Intermittent explosive disorder
    • Several discrete episodes of failure to resist aggressive impulses that result in serious assaultive acts or destruction of property
    • The degree of aggressiveness expressed during the episodes grossly out of proportion to any precipitating psychosocial stressors
    • The aggressive episodes are not better accounted for by another mental disorder (eg, antisocial personality disorder, borderline personality disorder, a psychotic disorder, or attention-deficit/hyperactivity disorder) and are not due to the direct physiological effects of a substance (eg, a drug of abuse, a medication) or a general medical condition (eg, head trauma, Alzheimer disease).
  • Kleptomania
    • Recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value
    • Increasing sense of tension immediately before committing the theft
    • Pleasure, gratification, or relief at the time of committing the theft
    • The stealing not committed to express anger or vengeance and not in response to a delusion or a hallucination
    • The stealing is not better accounted for by conduct disorder, a manic episode, or antisocial personality disorder.
  • Pyromania 
    • Deliberate and purposeful fire setting on more than one occasion
    • Tension or affective arousal before the act
    • Fascination with, interest in, curiosity about, or attraction to fire and its situational contexts (eg, paraphernalia, uses, consequences)
    • Pleasure, gratification, or relief when setting fires or when witnessing or participating in their aftermath
    • The fire setting not done for monetary gain, as an expression of sociopolitical ideology, to conceal criminal activity, to express anger or vengeance, to improve one's living circumstances, in response to a delusion or hallucination, or as a result of impaired judgment (eg, in dementia, mental retardation, substance intoxication)
    • The fire setting is not better accounted for by conduct disorder, a manic episode, or antisocial personality disorder.
  • Pathological gambling
    • Persistent and recurrent maladaptive gambling behavior as indicated by at least 5 of the following:  
      • Is preoccupied with gambling (eg, preoccupied with reliving past gambling experiences, handicapping or planning the next venture, or thinking of ways to get money with which to gamble)
      • Needs to gamble with increasing amounts of money in order to achieve the desired excitement
      • Has repeated unsuccessful efforts to control, cut back, or stop gambling
      • Is restless or irritable when attempting to cut down or stop gambling
      • Gambles as a way of escaping from problems or of relieving a dysphoric mood (eg, feeling of helplessness, guilt, anxiety, depression)
      • After losing money gambling, often returning another day after losing money gambling, to get even ("chasing" one's losses)
      • Lies to family members, therapist, or others to conceal the extent of involvement with gambling
      • Has committed illegal acts such as forgery, fraud, theft, or embezzlement to finance gambling
      • Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling
      • Relies on others to provide money to relieve a desperate financial situation caused by gambling
      • The gambling behavior is not better accounted for by a manic episode.

Paraphilias

According to the DSM-IV-TR, diagnostic criteria for paraphilias are as follows: 

  • Exhibitionism  
    • Over period of at least 6 months, recurrent intense sexually arousing fantasies, sexual urges, or behaviors involving exposure of one's genitals to an unsuspecting stranger
    • The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • Fetishism  
    • Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the use of nonliving objects (eg, female undergarments)
    • The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
    • The fetish objects are not limited to articles of female clothing used in cross-dressing (as in transvestic fetishism) or devices designed for the purpose of tactile genital stimulation (eg, a vibrator).
  • Frotteurism  
    • Over a period of at least 6 months, recurrent intense sexually arousing fantasies, sexual urges, or behaviors involving touching and rubbing against a nonconsenting person
    • The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • Pedophilia  
    • Over period of at least 6 months, recurrent intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (generally age 13 years or younger)
    • The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
    • The person is at least aged 16 years and at least 5 years older than the child or children in first criterion. (Note: Do not include an individual in late adolescence involved in an ongoing sexual relationship with a 12- or 13-year-old.)
  • Voyeurism  
    • Over period of at least 6 months, recurrent intense sexually arousing fantasies, sexual urges, or behaviors involving the act of observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity
    • The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Schizophrenia

Media hype to the contrary, most patients with schizophrenia generally do not pose an elevated risk of violence. However, one subgroup of patients with schizophrenia has an increased risk of violence and arrest. A significant degree of the criminality of schizophrenia is related to its symptoms, and criminality is reduced when the illness is treated. A study of 42 individuals found not guilty by reason of insanity (NGRI) found a high prevalence of schizophrenia and schizoaffective disorder with comorbid substance abuse.11 The current approach to schizophrenia treatment is multimodal, combining medications with psychological and social approaches.

Causes

Most psychiatric disorders are syndromes in that a specific cause is unknown. Contemporary psychiatry views psychiatric disorders as being multifactorial in origin and based upon a combination of heredity/biochemistry, environment, personality, and biochemistry, collectively known as the biopsychosocial theory.

Antisocial personality disorder

Heredity and environment are associated with this antisocial personality disorder. This disorder occurs 5 times more commonly in first-degree relatives of males with the disorder. Twin studies also support a genetic contribution to this disorder. Environmental studies find an association of this disorder with absent, abusive, or inconsistent parenting. In addition, the social learning theory is quite applicable to this disorder. Social learning theorists, especially Albert Bandura, argue that people are not born with the ability to act criminally, but rather they learn to be aggressive and commit crime through life experiences. Criminality is learned by modeling, based upon 3 principal sources: family members, environmental experiences, and the media.

Impulse control disorders

Kleptomania: Because few scientifically rigorous studies have been carried out, the etiology is unknown. Associations, which do not imply causality, have been found with depression, bipolar disorder, substance abuse, anxiety, and eating disorders. First-degree relatives have been found to have major mood disorders, substance abuse, or anxiety disorders.

Pyromania: Few scientifically rigorous studies have been performed; therefore, the etiology is unknown. Psychosocial hypotheses suggest this disorder may be understood as a communication from an individual with few social skills or a symbolic solution to conflict arising from ungratified sexuality. Low levels of serotonin are associated with violence and impulsivity.12

Pathological gambling: The etiology of pathological gambling is uncertain. Associations have been made with affective disorders, addiction, biological abnormalities, unconscious motivations, or behavioral anomalies.

Intermittent explosive disorder: The etiology is unclear, although an association with CNS dysfunction is apparent. Individuals with this disorder show abnormalities in neurological examination results, neuropsychologic test results, and EEG results. Associations have also been made with attention deficit hyperactivity disorder or learning disability. Research also has implicated abnormalities in levels of neurotransmitters and hormones.

Paraphilias: Little research exists on paraphilias, and the etiology of the disorder is unknown. A strong association has been established between this disorder and substance abuse, major depression or dysthymic disorder, and phobias. A finding suggestive of a psychological basis is that individuals with paraphilias have difficulty forming more socialized sexual relationships. One theory holds that paraphilias involve a conditioned response in which nonsexual objects become sexually arousing when paired with a pleasurable activity (eg, masturbating).

Treatment

Antisocial personality disorder

Little evidence exists that this disorder can be treated successfully with conventional psychiatric interventions. Antisocial personality disorder is among the disorders most resistant to treatment because these individuals have ego-syntonic symptoms and little incentive to change. Therapeutic rapport is tenuous at best, particularly since deception is a hallmark of this disorder. Insight-oriented psychotherapy is contraindicated due to the risk of inducing acting-out behavior in these individuals. Benzodiazepines are generally contraindicated due to the high frequency of substance abuse and diversion. However, antisocial behavior decreases with age. The most effective short-to-intermediate term treatment appears to be in residential or confined settings, where peer confrontation, behavior therapy, and empathy training and peer confrontation can occur.

Psychopharmacotherapy may be used to alleviate impulsivity and aggression. Treatment of comorbid conditions tends to be more successful, though less so as compared with individuals without this personality disorder.

Anxiety disorders

When not contraindicated by substance abuse or antisocial personality disorder, benzodiazepines provide immediate, short-term relief of anxiety, though the risk of abuse and dependence is an important consideration. Atypical antipsychotics, selective serotonin reuptake inhibitors (SSRIs), and serotonin/norepinephrine reuptake inhibitors (SNRIs) are also efficacious as both short- and long-term treatments. See Anxiety Disorders.

Mood disorders

For unipolar depression, SSRIs (eg, citalopram, fluoxetine, paroxetine, sertraline) and SNRIs (eg, venlafaxine duloxetine) are the treatments of choice. For bipolar spectrum disorders, lithium, valproic acid, lamotrigine, topiramate, and the atypical antipsychotics are efficacious treatments of choice.

Psychotic disorders

Atypical antipsychotics (eg, aripiprazole, olanzapine, quetiapine, risperidone) are the current treatment of choice for psychotic disorders. These medications efficaciously treat psychosis regardless of its etiology. However, these medications are not without risks and require evaluation of blood sugar, prolactin, and lipid levels. Although relatively uncommon, tardive dyskinesia (TD) has been reported with the atypical antipsychotics,13,14,15 and reports of TD in the atypical antipsychotics are likely to increase in the future, given nature of delayed onset in TD.

For noncompliant patients or those with gastrointestinal disease, depot forms of risperidone, haloperidol, and fluphenazine are available, while a depot form of paliperidone may be available in late 2008. First-generation antipsychotics are useful, particularly given the depot forms of haloperidol and fluphenazine. Haloperidol is the most frequently used antipsychotic in emergency departments and is relatively safe in the short term (note that it now carries a black-box warning for QT prolongation). Beta-blockers, valproic acid, and benzodiazepines are also effective in treating aggression in patients with schizophrenia.

Substance abuse and dependence

Acamprosate, naltrexone, atypical antipsychotics, valproate, topiramate, gamma-hydroxybutyric acid (GHB), and SSRIs (eg, citalopram, sertraline, fluoxetine) can reduce alcohol cravings. Disulfiram (Antabuse) does not treat alcohol craving, but it can reduce impulsive alcohol consumption. Gabapentin is efficacious in treating cocaine craving, anxiety, and withdrawal symptoms, particularly seizures that may occur in alcohol or benzodiazepine withdrawals.16 Topiramate is efficacious in treating opiate withdrawal.17 Despite advances in biological psychiatry, 12-step programs remain the mainstay of substance abuse treatment.

Impulse control disorders

Kleptomania: Treatment successes are difficult to identify due to the paucity of published case material. Nonpharmacologic measures include insight-oriented psychotherapy, systematic desensitization, assertiveness training, aversive conditioning, covert sensitization, and self-imposed banning by shoppers. Case reports note success with paroxetine, fluvoxamine, fluoxetine, lithium, valproate, amitriptyline, imipramine, nortriptyline, and trazodone.

Pyromania: Cognitive-behavioral treatment and fire safety education are effective in reducing fire involvement, fire interest, and risk. These interventions were more efficacious than home visits from a firefighter. The literature is lacking in reports about efficacious pharmacologic interventions.

Pathological gambling: Traditionally, psychoanalysis was the most commonly used treatment, but research on its efficacy is limited. Behavioral and cognitive-behavioral psychotherapies are proven efficacious, particularly when practitioners integrate social skills training, problem-solving, cognitive restructuring, and relapse prevention. In addition, pharmacotherapy with SSRIs, such as escitalopram and fluvoxamine, can be efficacious. Case reports noted the efficacy of lithium or clomipramine in treating pathological gambling. Use of 12-step programs, such as Gamblers Anonymous, may help in some cases, and, given its low risk of side effects, should be recommended routinely.

Intermittent explosive disorder: Acute management of violent behavior may involve use of physical restraint and medications, particularly antipsychotics and benzodiazepines. Psychopharmacotherapy and cognitive-behavior psychotherapy is efficacious with some patients over the short term. Carbamazepine, lithium, propranolol, and serotonin-selective medications such as buspirone and SSRIs have been beneficial.

Paraphilias: No evidence supports the efficacy of any specific modality. In particular, insight-oriented and supportive psychotherapy has been found to be relatively ineffective. Behavioral therapy, including aversive therapy, desensitization, social skills training, and orgasmic reconditioning, may be efficacious in some patients.

Anti-androgen medications, including intramuscular medroxyprogesterone acetate and cyproterone acetate, which are competitive inhibitors of androgen receptors, decrease testosterone levels and have been successful in decreasing aberrant sexual tendencies. Chemical castration may be achieved with the use of intramuscular leuprolide and triptorelin, synthetic gonadotropin-releasing hormone analogs that dramatically decrease testosterone levels; this may completely abolish deviant sexual tendencies. Oral estrogen in the form of ethinyl estradiol has been used less successfully to decrease aberrant sexual tendencies. The intensity of aberrant sexual urges may be attenuated by clomipramine and SSRIs, which act to decrease the compulsivity/impulsivity of the act.

Because these treatments affect significant others, including them in the informed consent process and educating them as to the impact of treatment interventions are important.

Ethical and Legal Issues

In clinical and forensic settings, confidentiality is an important consideration. Court-ordered evaluations limit but do not completely preclude confidentiality. Courts sometimes mandate psychiatric treatment for individuals as a condition of parole or probation. Again, confidentiality is limited, but nonetheless present. When working with court-ordered individuals, coordination of care with parole or probation officers is essential.

Because criminality is associated with harm toward others and recidivism, clinicians must continuously evaluate patients for dangerousness to themselves and others. When feeling trapped or when taken into custody, these individuals can become depressed and/or suicidal. Most jurisdictions require clinicians to protect or warn identifiable victims against patients, based upon California's Tarasoff decision.18 Other laws require reports to the authorities of reasonable suspicion of child, elder, and dependent adult abuse/neglect, and domestic violence. Because customs, practices, and laws vary, becoming familiar with the laws of your community is important.

Nonphysicians may try to pressure clinicians into making diagnoses where none exist. For example, clinicians should not diagnose a mental illness only because a patient holds different cultural, religious, or political beliefs. Similarly, they should not automatically diagnose mental illness in individuals merely because they have committed a criminal act. At the same time, physicians must be in a position to recognize and treat comorbid conditions, particularly substance abuse. Although intoxication can impair judgment, rarely do the courts excuse criminal activity undertaken by those under the influence of medications or illicit drugs.

Patient and Family Education

  • Family can provide collateral history and updates as to a patients’ psychiatric conditions. Collateral history is particularly important in substance abusers and sociopaths, who tend to be deceptive.
  • Family and couples therapy may be indicated to help significant others cope with patients’ behaviors and legal circumstances. In addition, self-help groups, such as Co-Dependents Anonymous (CODA) and Al-Anon, may benefit significant others.
  • The following Web sites can be useful for patient education.

Keywords

psychosis, psychopath, psychotic disorders, sociopath, criminality, criminal, defendant, litigant, criminal behavior, nonconformist behavior, impulse control, impaired judgment, suspiciousness, disinhibition, paranoia, impaired communication skills, impaired social interaction, psychiatric disorder, criminality, antisocial personality disorder, impulse control disorder, intermittent explosive disorder, kleptomania, pyromania, pyromaniac, kleptomaniac, gambling, paraphilias, exhibitionism, voyeurism, frotteurism, pedophilia, schizophrenia, tardive dyskinesia

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors William H Wilson, MD and Kathleen A Trott, MD to the development and writing of this article.



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References
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Further Reading

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Keywords

psychosis, psychopath, psychotic disorders, sociopath, criminality, criminal, defendant, litigant, criminal behavior, nonconformist behavior, impulse control, impaired judgment, suspiciousness, disinhibition, paranoia, impaired communication skills, impaired social interaction, psychiatric disorder, criminality, antisocial personality disorder, impulse control disorder, intermittent explosive disorder, kleptomania, pyromania, pyromaniac, kleptomaniac, gambling, paraphilias, exhibitionism, voyeurism, frotteurism, pedophilia, schizophrenia, tardive dyskinesia

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Contributor Information and Disclosures

Author

Michael Menaster, MD, MA, General and Forensic Psychiatrist, Private Practice
Disclosure: Nothing to disclose.

Medical Editor

Denis F Darko, MD, Executive Director, Clinical Research and Development, Neuroscience Global Licensing Medical Director, Clinical Neuroscience Therapy Area and CNS and Pain Control Research Area, AstraZeneca LP
Denis F Darko, MD is a member of the following medical societies: American College of Physicians and American Psychiatric Association
Disclosure: AstraZeneca Salary Management position

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

David Bienenfeld, MD, Vice-Chair, Program Director, Professor, Department of Psychiatry, Wright State University School of Medicine
David Bienenfeld, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, and Association for Academic Psychiatry
Disclosure: Nothing to disclose.

CME Editor

Harold H Harsch, MD, Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin
Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: lilly Honoraria Speaking and teaching; BMS Honoraria Speaking and teaching; Forest Labs Honoraria Speaking and teaching; AstraZeneca Honoraria Speaking and teaching; Pfizer Grant/research funds Other; Northstar Grant/research funds Other; Novartis  Other; Pfizer Honoraria Speaking and teaching

Chief Editor

Stephen Soreff, MD, President of Education Initiatives, Nottingham, NH; Faculty, Metropolitan College of Boston University, Boston, MA
Stephen Soreff, MD is a member of the following medical societies: American College of Mental Health Administration and American Psychosomatic Society
Disclosure: Nothing to disclose.

 
 
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