Alec Buchanan, PhD, MD
Professor Emeritus of PsychiatryCards
Appointments
Contact Info
Division of Law and Psychiatry
34 Park Street
New Haven, CT 06519
United States
About
Titles
Professor Emeritus of Psychiatry
Appointments
Psychiatry
EmeritusPrimary
Other Departments & Organizations
Education & Training
- MD
- University of Edinburgh (1996)
- PhD
- Cambridge University (1996)
- MPhil
- Cambridge University, Criminology (1993)
- MPhil
- University of London, Psychiatry (1991)
- MBChB
- University of Edinburgh (1981)
Research
Overview
The management of the risk of harm to others is an essential aspect of psychiatric care. While psychiatric patient populations, as a whole, do not show substantially higher rates of violence than the general population, it is possible, as with the general population, to identify sub-groups who have a higher risk. This is usually done using information derived from a clinical interview and from the patient's background, including details of illness, drug use and past violence. Some of our research has been designed to measure the relative contributions of each of these to accurate predictions. At least when predictions are made over the long term, a history of violence seems to carry the greatest weight.
The next question that arises is to what extent psychiatric services are likely to be able to use these predictions to prevent violence. Here the most important factor seems to be the base rate of violence in the population (see Psychiatric Services 2008; 59, 184-190). At the base rates of violence seen in most psychiatric patient populations, the limits to predictive accuracy are such that most violent acts could only be prevented by admitting to hospital large numbers of people most of whom would not, in fact, have gone on to cause harm. Even then, many of those who would have acted violently would have been left in the community. Psychiatric services do not have the option of ignoring the risk of harm to others. But our research suggests that admission to hospital, whether compulsory or voluntary, should be based on a range of clinical considerations, not just violence risk.
Risk assessment and management in the context of out-patient psychiatric treatment is discussed along with other aspects of forensic psychiatric care in the second edition of Care of the Mentally Disordered Offender in the Community (A. Buchanan, L. Wootton eds., Oxford, 2017).
Psychiatric jurisprudence is the philosophy of law as it applies to the mentally disordered. It forms the theoretical basis for the clinical sub-specialty of forensic psychiatry. Mentally disordered people encounter the law in proceedings relating to hospital commitment, in criminal trials and in civil cases, including medical malpractice and negligence. A recurring question has been whether legal standards, such as those relating to competence to stand trial or make a will, should change according to what is at stake (see Journal of the American Academy of Psychiatry and the Law 2006; 34, 458-465). There are several possibilities and the answer may not be the same for criminal and civil cases. Other aspects of our research have concerned the "ultimate issue" question in criminal testimony and the use of psychiatric diagnoses in authorizing the detention of those convicted of sexual offenses.
Psychiatric jurisprudence is the subject of Psychiatric Aspects of Justification, Excuse and Mitigation (A. Buchanan, Jessica Kingsley, 2000). The preparation of psychiatric reports for courts is the subject of The Psychiatric Report (A. Buchanan, M. Norko, eds., Cambridge, 2011), which won the American Psychiatric Association's Guttmacher Award in 2013.
Medical Subject Headings (MeSH)
Research at a Glance
Yale Co-Authors
Publications Timeline
Research Interests
Elina A. Stefanovics, PhD
Michael Norko, MD, MA
Robert Rosenheck, MD
Sherry McKee, PhD
Mental Disorders
Publications
2024
Mute by Visitation of God, Competency to Stand Trial and Fitness to Plead.
Buchanan A. Mute by Visitation of God, Competency to Stand Trial and Fitness to Plead. The Journal Of The American Academy Of Psychiatry And The Law 2024, 52: 207-215. PMID: 38834365, DOI: 10.29158/jaapl.240005-24.Peer-Reviewed Original ResearchMeSH Keywords and ConceptsConceptsVisitation of GodFairness of criminal proceedingsEnglish legal termsCriminal proceedingsLegal commentaryLegal termsEnglish attemptsRelevant historical backgroundDefendantHistorical backgroundHistorical exegesisOrigins of competenceGodPleadingsLawProceedingsCompetenceDignityFairnessCommentaryExegesisConcernsPeople
2023
Victimization in schizophrenia and its relation to violence
Buchanan A, Stefanovics E, Rosenheck R. Victimization in schizophrenia and its relation to violence. Schizophrenia Research 2023, 255: 52-58. PMID: 36963231, DOI: 10.1016/j.schres.2023.03.018.Peer-Reviewed Original ResearchCitationsAltmetricMeSH Keywords and ConceptsConceptsIntervention Effectiveness (CATIE) trialMental health symptomsStudy entryCross-sectional designAntipsychotic treatmentEffectiveness trialSchizophrenia symptomsMultivariate analysisHealth symptomsSchizophreniaViolent behaviorSubstance useSymptomsRecent victimizationPotential causesAggressive behaviorChildhood experiencesBaselineMore incidentsCorrelatesTreatmentVictims of violenceSexual abuseClose friendsMost perpetratorsPsychosocial function, legal involvement and violence in mental disorder – CORRIGENDUM
Buchanan A, Moore K, Pittman B, McKee S. Psychosocial function, legal involvement and violence in mental disorder – CORRIGENDUM. European Psychiatry 2023, 66: e8. PMID: 36632793, PMCID: PMC9879851, DOI: 10.1192/j.eurpsy.2022.2358.Peer-Reviewed Original ResearchMeSH Keywords
2021
Psychosocial function, legal involvement and violence in mental disorder
Buchanan A, Moore KE, Pittman B, McKee SA. Psychosocial function, legal involvement and violence in mental disorder. European Psychiatry 2021, 64: e75. PMID: 34859762, PMCID: PMC8715282, DOI: 10.1192/j.eurpsy.2021.2250.Peer-Reviewed Original ResearchCitationsAltmetricMeSH Keywords and ConceptsConceptsPsychosocial functionAssociated Disabilities Interview Schedule-5Mental disordersWorse psychosocial functionDSM-5 categoriesAlcohol use disorderLongitudinal designSchedule 5Significant outcomesLegal involvementUse disordersPersonality disorderEffect sizeDrug abuseNational Epidemiologic SurveyAlcohol abuseMental illnessDisordersAbuseLifetime outcomesPeopleRepresentative sampleRelated conditionsSocial networksForm Health Survey version 2Uses of video recorded interviews in court by clinical expert witnesses
Gunn J, Calcedo A, Albrecht H, Nedopil N, Schiltz K, Buchanan A, Kennedy H, Davoren M, Taylor PJ. Uses of video recorded interviews in court by clinical expert witnesses. Criminal Behaviour And Mental Health 2021, 31: 226-230. PMID: 34392576, DOI: 10.1002/cbm.2209.Peer-Reviewed Original ResearchCitationsAltmetricMeSH Keywords
2020
An 18-month longitudinal study of suicidality in patients diagnosed with schizophrenia
Buchanan A, Sint K, Stefanovics E, Rosenheck R. An 18-month longitudinal study of suicidality in patients diagnosed with schizophrenia. Schizophrenia Research 2020, 224: 102-107. PMID: 33046335, DOI: 10.1016/j.schres.2020.09.019.Peer-Reviewed Original ResearchCitationsAltmetricMeSH Keywords and ConceptsConceptsRisk factorsSevere suicidalityHazard ratioDepression scoresIntervention Effectiveness (CATIE) trialMultivariate hazard ratiosHigh-risk groupImportant risk factorPotential risk factorsProportional hazards modelPutative risk factorsSubjects' depression scoresSymptoms of schizophreniaUnstable illnessAntipsychotic treatmentPatient populationSelf-reported suicide attemptsClinical changesEffectiveness trialHigh riskPsychotic decompensationPsychotic symptomsHazards modelMultivariate analysisPrior suicidality
2019
Correlates of Future Violence in People Being Treated for Schizophrenia
Buchanan A, Sint K, Swanson J, Rosenheck R. Correlates of Future Violence in People Being Treated for Schizophrenia. American Journal Of Psychiatry 2019, 176: 694-701. PMID: 31014102, DOI: 10.1176/appi.ajp.2019.18080909.Peer-Reviewed Original ResearchCitationsAltmetricMeSH Keywords and ConceptsConceptsClinical Antipsychotic TrialsRecent violent victimizationStudy entryMedication adherenceMultivariable analysisMental Health Clinical Antipsychotic TrialsInjurious violenceMultivariable hazard ratiosPoor medication adherenceIntervention Effectiveness (CATIE) studyLongitudinal multivariable analysesProportional hazards modelChildhood risk factorsHazard ratioMedication nonadherenceClinical variablesRisk factorsTreatment strategiesAntipsychotic TrialsBaseline symptomsClinical conditionsLarge cohortHazards modelDrug useEffectiveness studies
2017
Correlates of Reduced Violent Behavior Among Patients Receiving Intensive Treatment for Posttraumatic Stress Disorder
Buchanan A, Stefanovics E, Rosenheck RA. Correlates of Reduced Violent Behavior Among Patients Receiving Intensive Treatment for Posttraumatic Stress Disorder. Psychiatric Services 2017, 69: 424-430. PMID: 29241432, DOI: 10.1176/appi.ps.201700253.Peer-Reviewed Original ResearchCitationsAltmetricMeSH Keywords and ConceptsConceptsPosttraumatic stress disorderIntensive treatmentStress disorderSubstance useWar-related posttraumatic stress disorderPTSD symptomatologySpectrum of careProgram entryViolent behaviorU.S. military veteransModerate effect sizeClinical factorsPTSD symptom severityShort-term supportObservational studyBaseline levelsPTSD programSymptom severitySpecific causesFour monthsPTSD changeMilitary veteransIncarceration historyEffect sizeTreatment
2015
Resource Document on Psychiatric Violence Risk Assessment
Buchanan A, Binder R, Norko M, Swartz M. Resource Document on Psychiatric Violence Risk Assessment. FOCUS The Journal Of Lifelong Learning In Psychiatry 2015, 13: 490-498. DOI: 10.1176/appi.focus.130402.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsCitationsRespect for dignity and forensic psychiatry
Buchanan A. Respect for dignity and forensic psychiatry. International Journal Of Law And Psychiatry 2015, 41: 12-17. PMID: 25888501, DOI: 10.1016/j.ijlp.2015.03.002.Peer-Reviewed Original ResearchCitationsAltmetricMeSH Keywords and Concepts
Academic Achievements and Community Involvement
honor Guttmacher Award
National AwardAmerican Psychiatric AssociationDetails05/01/2013United Stateshonor Keynote Speaker
International AwardSpanish National Congress of PsychiatryDetails01/01/2009United Stateshonor Keynote Speaker
International AwardJapanese Society of Forensic Mental HealthDetails01/01/2008United Stateshonor Fellow
International AwardRoyal College of PsychiatristsDetails01/01/2005United States
Links & Media
News
- April 24, 2019Source: The American Journal of Psychiatry
Yale study: Correlates of future violence in people being treated for schizophrenia
- February 12, 2019Source: The Journal of Clinical Psychiatry
Psychiatric disorders and crime in the U.S. population: Results from the National Epidemiologic Survey on Alcohol and Related Conditions
- January 29, 2019Source: VA Connecticut Healthcare System Intranet
Point in Time Count 2019
- September 25, 2018
Buchanan book 'Highly Commended' by British Medical Association
Get In Touch
Contacts
Division of Law and Psychiatry
34 Park Street
New Haven, CT 06519
United States
Locations
Law and Psychiatry
Academic Office
Connecticut Mental Health Center
34 Park Street
New Haven, CT 06519