Insanity defense raised for youth accused of Landstown plot

Kathy Adams reports that the defense attorney for a former student accused of a Columbine-style plot against a high school will plead that the young man was insane due to Bipolar Disorder and PTSD due to a history of child abuse and bullying:

Philip C. Bay, the former student accused of a plot against Landstown High School, began “the countdown to terror” on April 16, 2007, the day of the Virginia Tech massacre, Commonwealth’s Attorney Harvey Bryant told jurors as Bay’s trial got underway Monday afternoon.

Bryant called Bay “the mastermind, the bomb-maker and the recruiter for this suicide mission,” and said Landstown notebooks, calendars and photos will help prove Bay set out to kill at least 30 people.

He read journal entries he said were Bay’s, including this: “I will be armed to the teeth with guns, knives and everything else. I will kill, kill, kill. You have my word.”

An attorney helping defend Bay, Eric Korslund, said the defense will argue he was insane at the time of the crimes. He suffered from untreated bipolar disorder and post-traumatic stress disorder from being bullied and abused as a child, he said.

[...]

Bay’s attorney, James Broccoletti, said during jury selection that Bay’s mental condition was the central issue.

“The defense is that Philip Bay was legally insane at the time of the acts alleged in the indictment,” Broccoletti told potential jurors. “That means that because of a mental disease or defect, he did not understand the nature, the character or the consequences of his actions or could not understand right from wrong.”

Bay was 17 when he was charged in 2009 in connection with what authorities called a plot against the school. He faces 11 counts of manufacturing or possessing an explosive device with intent to cause harm; possessing a weapon of terrorism with intent to terrorize; two counts of possessing a sawed-off shotgun; soliciting or recruiting for an act of terrorism; and committing, conspiring or aiding in the commission of an act of terrorism.

Read more on Hampton Roads.

Bipolar Disorder can, in severe forms, be accompanied by psychotic thinking. But if planning took place over time measured in weeks or longer, I think the defense has its work cut out for it if it plans to claim that at no point was the young man sane and fully aware that what he was planning to do was wrong.

I’d really be curious to read any psychiatric or psychological evaluation of the defendant conducted at the time of his arrest.

More information on the use of the insanity defense in Virginia can be found here.  He may wind up being incarcerated for longer than he might for a straight prison sentence, depending….

New Findings on Heritability of PTSD

Rick Nauert PhD describes some new research that links genetics to Post-Traumatic Stress Disorder (PTSD) and likelihood that cognitive-behavior therapy (CBT) will be effective:

In their new study appearing in Biological Psychiatry, Dr. Richard Bryant and colleagues assessed whether serotonin transporter genotype predicted a change in patients’ PTSD severity following treatment.

Specifically, patients with PTSD were classified according to their genotype, and they received eight weeks of cognitive behavioral therapy.

Approximately one third of patients do not respond to this treatment, and this study has now demonstrated that there may be a genetic basis for not responding to this therapy.

Dr. Bryant explained: “Patients with PTSD who carried the short allele of the serotonin transporter gene promoter responded more poorly to treatment than other PTSD patients. This study highlights that the serotonin system is implicated in responding to cognitive behavior therapy.”

Read more on PsychCentral.

To read the research report, the citation is:

Biol Psychiatry. 2010 Jun 15;67(12):1217-9.
Preliminary evidence of the short allele of the serotonin transporter gene predicting poor response to cognitive behavior therapy in posttraumatic stress disorder.
Bryant RA, Felmingham KL, Falconer EM, Pe Benito L, Dobson-Stone C, Pierce KD, Schofield PR.

School of Psychology, University of New South Wales, Sydney, Australia. r.bryant@unsw.edu.au

Abstract

OBJECTIVE: This study was intended to assess the extent to which the low-expression alleles of the serotonin transporter gene promoter predict poor response to cognitive behavior therapy in patients with posttraumatic stress disorder (PTSD). METHOD: Forty-five patients with PTSD underwent an 8-week exposure-based cognitive behavior therapy program and provided mouth swabs or saliva samples to extract genomic DNA and classify individuals according to four allelic forms (S(A), S(G), L(A), L(G)) of the 5-HTT-linked polymorphic region (5-HTTLPR). We determined whether the 5-HTTLPR genotype predicted change in PTSD severity following treatment (n = 45) and 6 months later (n = 42). RESULTS: After controlling for pretreatment PTSD severity and number of treatment sessions, the 5-HTTLPR low-expression genotype group (S or L(G) allele carriers) displayed more severe PTSD 6 months following treatment relative to other patients. CONCLUSIONS: This study suggests a genetic contribution to treatment outcome following cognitive behavior therapy and implicates the serotonergic system in response to exposure-based treatments in PTSD.

States Differ on Marijuana for PTSD

Dan Frosch reports:

A decade ago, Colorado became one of the earliest states to legalize medical marijuana. Its neighbor New Mexico did so more recently. But that does not mean the two Western states agree on all the medicinal merits of cannabis.

Both states allow marijuana to be used to treat the symptoms of a variety of diseases, like AIDS and cancer. When it comes to treating post-traumatic stress disorder, however, New Mexico says yes to medical marijuana, while Colorado’s answer is a resounding no.

Read more in The New York Times.

Experimental approaches to treating Post-Traumatic Stress Disorder

Shirley S. Wang has an article in today’s Wall Street Journal that describes some current research approaches to reducing the anxiety experienced in conditions such as Post-Traumatic Stress Disorder (PTSD). While some approaches involve behavioral treatments, another promising approach uses a common hypertension medication to create a disconnection between the memory of the event and the emotional response to it.

The goal of the research isn’t to erase memory outright, as depicted in popular movies over the years. That would raise ethical issues and questions of what would happen to associated memories, scientists say. Instead, “reducing or eliminating the fear accompanying the memory…that would be the ideal scenario,” says Roger Pitman, a psychiatry professor at Harvard Medical School who has done extensive work in this area.

As an example of the medication approach, which is now being pursued in a larger-scale study, Wang describes a clinical case:

In a recent study, Harvard’s Dr. Pitman and Alain Brunet, a psychiatry professor at McGill University, treated a Montreal man who had developed symptoms of post-traumatic stress disorder after being hit on the head with the butt of a gun and fearing for his life during a bank holdup. The man gave up his long-time hobby of bird watching and broke up with his romantic partner. And he became house bound, because he felt unsafe whenever he went outside, Dr. Brunet says.

The man received six treatment sessions, Dr. Brunet says. At each session, he would revisit the original memory after being given the drug propranolol, a hypertension medication that reduces common symptoms of fear, which include a speeded-up heart rate and excessive sweating. By the fifth treatment, Dr. Brunet says, the man said he felt remote when reading the script he had written. Now, two years after the treatment, the man has resumed his normal activities and says that although he remembers the events at the bank, he doesn’t feel scared anymore, Dr. Brunet says.

Read more

DSM-V: Additions to childhood-onset disorders

Among the many changes proposed for the DSM-V are the inclusion of disorders not currently listed in the DSM-IV-TR. Clicking on the links below will take you the related sections of the DSM-V web site where you can read the proposed diagnostic criteria for these new diagnoses as well as the rationale for proposing each one:

• Posttraumatic Stress Disorder in Preschool Children
• Temper Dysregulation Disorder with Dysphoria
• Callous and Unemotional Specifier for Conduct Disorder
• Learning Disabilities
• Non-Suicidal Self Injury
• Non-Suicidal Self Injury Not Otherwise Specified

The Temper Dysregulation Disorder with Dysphoria proposal is particularly controversial and will be discussed in a separate post when we consider changes affecting children with mood disorders.