Dr. Adhia is triple-Board-Certified in Forensic Psychiatry, Brain Injury Medicine and Psychiatry. He assesses emotional distress and mental health injuries as well as brain injury concerns. Triggers considered are personal injury, undue influence, changed competency, medical malpractice, physical and emotional abuse, violence, and criminal behavior.

Currently, Dr. Adhia is an Assistant Professor of Psychiatry at Memorial Herman TIRR where he focuses on patients with brain and spinal cord injuries. Dr. Adhia was the Medical Director of Pace Mental Health, serving the community in Houston, TX where he treated general psychiatric patients and provided Medication Assisted Treatment to those with Opioid Use Disorders.

Dr. Adhia has clinical experience in high-risk and security-sensitive settings, maximum security prisons and correctional psychiatric hospitals, inmates on Death Row and segregated in Isolation. Dr. Adhia also volunteers with Physicians for Human Rights, Asylum Network, conducting forensic assessments of victims of kidnapping and false imprisonment, human trafficking, undue influence, physical and sexual abuse and rape.

Dr. Adhia is skilled in evaluating PTSD, Anxiety and Depressive Disorders, risk of suicide, and malingering. He is experienced in the impact of drug and alcohol abuse on decision-making. In psychiatric hospitals, Dr. Adhia treats psychosis: Schizophrenia and Psychotic Disorders (hallucinations, delusions.)

Dr. Adhia’s findings consider complicating factors, such as emotional distress worsened by physical and emotional isolation from family and support (e.g., prisoner or elder.) Pre-existing mental and physical illness, competency and capacity (e.g. dementia, Intellectual Disability) and medication or addiction may also be relevant to his opinions.

Dr. Adhia opines about medical malpractice and standard of care, including in government regulated and institutional settings.

Dr. Adhia conducts Independent Medical Examinations and review of records, issuing his med-legal findings by report, testimony or private consultation. Dr. Adhia is available to testify as an expert witness in civil, criminal, military, probate, Federal, Immigration and administrative jurisdictions.

Date Rape Drugs: Psychiatry, Pharmacology and Law Weaponized Chemistry: a Medicine Cabinet of Assault https://www.forensicpsychiatrynow.com/date-rape-drugs-sexual-assault/ By Sanjay Adhia, M.D. DFSA IS THE USE OF DRUGS AND/OR ALCOHOL BY A SEXUAL PREDATOR TO RENDER A VICTIM INCAPACITATED AND UNABLE TO FIGHT BACK AGAINST A SEXUAL ASSAULT. Drug-Facilitated Sexual Assault (DFSA) DFSA is the use of drugs and/or alcohol by a sexual predator to render a victim incapacitated and unable to fight back against a sexual assault. A side effect of many “Date Rape” or “Club Drugs” is also anterograde amnesia, the inability to recall what happened while drugged, increasing a predator’s belief he will “get away with it.” Those odds are shifting, but attorneys, Courts, and potential victims are better served if they understand some of the drugs used and their impact on mind and body. Testing and Prosecution DFSA is more easily prosecuted if reported while the drug is still in the victim’s system and thus testable by a toxicology screen. Each drug has a different deterioration time for detection. Luckily, law enforcement protocols now better respond with urgency to obtain a blood test when a DFSA is reported. The Drug-Induced Rape Prevention and Punishment Act of 1996 provides for more severe sentencing. Public awareness, particularly after the Bill Cosby trials, has made potential victims warier of at least the most obvious DFSA attempts. What, Where and How Drug-Facilitated Sexual Assault can involve any sexual assault including rape. These predator drugs also go by the name “date rape” drugs and “Club Drugs.” They are any drug that is an “incapacitating agent”[1] which renders the victim vulnerable to sexual assault. The drugs can come in different forms such as liquid, powder or pill. Each has a different medical profile and behavior in the body. The onset of effects can be 15-30 minutes, and last hours. They typically will decrease inhibition, cause disorientation, impair motor ability, and memory. The drugs can lead to coma or death, particularly if they are mixed. Alcohol “Get her drunk,” says one man to another, “works every time.” Alcohol is one of the most common DFSAs because alcohol and the victim’s initial participation are easy to acquire. The use of alcohol to coerce sexual compliance is universally acknowledged in many alcohol-drinking cultures. The victim’s consent, however, stops when her judgment has become impaired. Impairment is a natural side effect of alcohol consumption. Obviously, accepting a drink is not an invitation to be raped. Alcohol consumption affects judgment by impacting the inaccurate appraisal of a partner’s sexual motives and intentions.[2] It impairs communication and the ability to correct any misperceptions. Alcohol can lead to aggressive behavior, especially relevant when an attacker is also drinking alcohol at the time of the assault. Alcohol impairs motor function, which is why people slur their words, or cannot easily walk in a straight line. They may lose the muscle control to “fight back” effectively. Tranquilizers / Sedative-Hypnotics A tranquilizer, in clinical strengths and for treatment purposes, is a drug used to calm a person, help them sleep or reduce anxiety. Since the 1970’s and 80’s we rarely see the use of Quaaludes (a horse tranquilizer,) in a drug-facilitated sexual assault. It has been replaced as a predator’s drug of choice several times over. The fact is all drugs which sedate can be manipulated by dosage to change a victim’s response. Ambien (Zolpidem) is usually used for sleep; it is also used as a date rape drug because its side effects can be amnesia of events that occur while under the influence of Zolpidem. It reduces reaction time, impairs mental functioning and judgment, and causes confusion, an ideal scenario for a sexual predator. Benzodiazepines A class of drugs known as Benzodiazepines or Benzos includes Xanax, Valium, Ativan, Klonopin (clonazepam) and Rohypnol (flunitrazepam.) Like Zolpidem, many of these agents are used to treat sleeplessness and anxiety. They are also commonly used recreationally, making it possible for the assailant to characterize the offered drug as a recreational level of strength, while the predator substitutes a much stronger dose or a different drug altogether. Rohypnol (pron. rōˈhipˌnōl). Rohypnol, or “Roofies” is the most notorious benzodiazepine used to facilitate rape. However, its use has dropped dramatically in the last 20 years, replaced by more sophisticated chemistry. In the past, Roofies were colorless when added to a drink. Roofies now release a dye in the pill which would, if crushed into the drink, alter its color. In a clear liquid, like Vodka, Roofies now generally turn the colorless drink blue if the Roofie is the only drug used. If enough is taken, it can create a state of automatism (actions taken without thought or mental control) or dissociation (a feeling of being separate from reality and what is occurring.) Sleepwalking, for example, is a form of automatism. After the effects of Rohypnol wear off, the victim may not recall what happened while intoxicated. It may result in a woozy hang-over where one will feel sluggish and dizzy and lacking coordination. Because of retrograde amnesia and confusion, DFSAs are often not reported, making it difficult to statistically identify which drugs are used and how often. In one case, research reported attribution of only 1% of DFSAs to Rohypnol. What is known for certain is that the use of specific date rape drugs of the 1990s has changed. GHB Gamma-hydroxybutyrate (GHB) is a depressant of the central nervous system, sold under names like G and Liquid X. It is odorless and tastes salty. GHB is used recreationally, and its effects include euphoria, enhanced sociability, increased libido, and disinhibition. One study attributed 4% of DFSA to GHB. While the conclusions are interesting, reliability of the research is not conclusive. Some authorities report GHB use has surpassed Rohypnol. The advantages to a predator of GHB over Rohypnol include its price, availability and that it leaves the body more quickly, making it more difficult to test when an assault is reported to law enforcement. GHB can produce both stimulating and sedating effects. GHB can be neurotoxic and has resulted in fatalities. Ketamine Ketamine is a dissociative anesthetic with some hallucinogenic effects. It can be mixed with ease in drinks as it is in the form of a clear liquid or white powder. It is extremely bitter. Ketamine can also be added to a cigarette. It can be mixed with Ecstasy, amphetamines or cannabis. Incidentally, ketamine is emerging as a treatment for depression. Ecstasy Ecstasy (MDMA) is a psychedelic. While it has been used to commit sexual assault, MDMA is not sedating like the other preceding agents. It is an empathogen and can increase disinhibition and sexual desire. This could limit a victim’s ability for providing reasoned consent. Often Ecstasy is cut with amphetamines or other drugs. Sometimes Ecstasy can contain little or no MDMA. Proactive Defense We know date rape/club drugs are used when there is no social setting at all, although the name implies use on a date, clubbing, partying, or otherwise. Allegations against Bill Cosby, for example, suggest the only requirement is for predator and victim to be in the same room at the same time. In any sexual assault, including with the use of drugs and alcohol, “compliance” (not consensually) by the victim in ingesting the drug is made easier when the assailant earns the impression of trustworthiness by a shared acquaintanceship, personal relationship or even social circle. Women and men on guard against sexual assault are more aware than ever before that they must not assume trustworthiness by association (e.g. a friend of a friend.) That said, drugs of all kinds, including recreational drugs, can mask a more sinister purpose. The buddy system is a good idea for both kindergarteners and clubbers: party with a close friend. Don’t accept, or purchase, drugs from a stranger, and watch your body for an unexpected response. For example, if Ecstasy is sedating, something is wrong. Other tips include drinking slowly, keeping an eye on your beverage from when it’s poured to the last sip and obtaining a fresh drink after leaving it unattended.[3] If you suspect you have been sexually assaulted under the influence of a date rape drug, report it to law enforcement immediately. Even if your recollection is impaired, a rape kit and toxicology screen doesn’t require a lucid memory and is essential to a prosecutor when there has been a drug-facilitated sexual assault and suspected assailants. End Notes:[1] “Incapacitating Agent, Department of Defense/Wikipedia”: The term incapacitating agent is defined by the U.S. Department of Defense as “An agent that produces temporary physiological or mental effects, or both, which will render individuals incapable of concerted effort…” See also Butler, B., & Welch, J. (2009) Drug-facilitated sexual assault. CMAJ : Canadian Medical Association Journal, 180(5), 493–494. http://doi.org/10.1503/cmaj.090006 [2] Coreen Farris et al (2008) Sexual Coercion and the Misperception of Sexual Intent, Clinical Psychology Review 28(1): 48–66. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2885706/ [3] Erica Weir (2001) Drug-facilitated Date Rape, CMAJ : Canadian Medical Association Journal, 165 (1) 80; http://www.cmaj.ca/content/165/1/80 First Posted May 15, 2018Sanjay Adhia, M.D., Forensic Psychiatrist

What is Brain Injury Medicine? When Brain Injury Medicine Board-Certification is important in an Expert Witness. https://www.forensicpsychiatrynow.com/case-study-summary/brain-injury-medicine/ By Sanjay Adhia, M.D. (Dr. Adhia is one of fewer than a dozen doctors in the US with Board-Certification in both Forensic Psychiatry and Brain Injury Medicine.) What is Brain Injury Medicine? Brain Injury Medicine encompasses disorders of brain function due to injury with an emphasis on treatment and recovery. These disorders involve a range of medical, physical, neurological, cognitive and psychiatric disorders with consequences for key areas of life: Psychosocial (relating social conditions to mental health) Educational Skills, acquiring new skills or skills a person had previously but is impaired after a brain injury Job / vocational Occupational Medicine, the ability to master day to day skills like hygiene, cooking or driving A specialist in BIM would have expertise in other central nervous system disruptions (e.g., encephalopathies, anoxia) with similar neurocognitive and psychiatric symptoms. Qualified Brain Injury Medicine Expert Witness – Subspecialty Board-Certification Enhancing a Forensic Psychiatrist’s Opinions I am Board-Certified in Brain Injury Medicine as well as Psychiatry and Forensic Psychiatry by the American Board of Psychiatry and Neurology (ABPN). Board-Certification follows a rigorous course of study and examination. Qualified Board-Certified Psychiatrists, Neurologists, Physiatrists (Physical Medicine and Rehab) and Sports Medicine physicians are permitted to take the exam. Why Brain Injury Medicine and Forensic Psychiatry Qualifications? ​BIM qualifications enable the forensic psychiatrist to treat and render medico-legal opinions on the neuropsychiatric manifestations of Traumatic Brain Injury (TBI) with a high level of expertise. The psychiatrist with this training is not a substitute for a Neurologist. The relationship between Brain Injury and Psychiatry speaks to behavior, personality and emotional response-the primary purview of the Psychiatrist. There is overlap with Neurology and it may make sense in a lawsuit involving a brain injury, or suspected brain injury, to assemble a team of experts including a Forensic Psychiatrist with BIM Board Certification, a Neurologist and a Neuropsychologist who is trained to conduct testing and interpret data. Applications in Law Criminal Allegations and TBI About half of all criminal offenders have a history of TBI. In criminal cases, TBI may play a role in Mitigation, Competency to Stand Trial and Insanity (NGRI) questions. A brain injury can interfere with decision-making, clarity and even behavior, including criminal behavior. Personal Injury cases If a physical injury to the body includes the brain, such as a motor vehicle accident, psychiatric conditions should not be automatically attributed as an emotional response to the accident. If an MVA results in chronic pain associated with, for example, a back injury, we might see severe depression. It is logical for an attorney, or even a psychiatrist without BIM or Forensic training to conclude the depression is associated with pain or prognosis that changes the ability to work or family dynamics. If the Depression is related to a brain injury, diagnosis, prognosis and, ultimately, damages awarded in litigation, can look very different. If one expert believes brain injury to drive other psychiatric conditions, but that expert does not have the qualifications to opine in this way, it behooves an attorney to consider an expert witness who is better qualified in this area. Testimony is only one piece. An attorney preparing to depose an expert witness who has rendered an opinion might want to consult with a BIM Board-Certified doctor to prepare questions that invite a better understanding of an expert’s opinions–including if they are founded on sound experience and qualifications. Competency, Testamentary Capacity, Undue Influence Brain function impacted by Dementia or Alzheimer’s Disease is degenerative. Competency implies the exercise of free will with clear-thinking and lucid decision-making–and a functioning brain. Testamentary Capacity cases, and susceptibility to undue influence, especially alleged in the elderly, (brain function can impact vulnerability and emotional decision-making), Disability and other cases. Please call me to discuss your Brain Injury case.

How PTSD is Evaluated in a Medico-Legal / Forensic Setting By Sanjay Adhia, M.D. https://www.forensicpsychiatrynow.com/ptsd/ What is PTSD? PTSD, or Post-Traumatic Stress Disorder, is a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as violence, war, rape or serious accident. Prior generations associated PTSD primarily with military service and referred to PTSD as “shell shock” or “combat fatigue”. We now know that PTSD is by no means limited to battle. Close to 7% of all people in the United States experience PTSD at some point in their life. How is PTSD diagnosed? Criteria for a Diagnosis of PTSD A diagnosis of PTSD requires direct or indirect exposure to trauma. This is defined by the DSM5* as “death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence”. Some refer to this as the “gatekeeper” criterion. Confusing Trauma with Other Stressors Often, I will hear someone mention that a break-up or a job loss caused PTSD. Although such stressors can affect someone with pre-existing PTSD, it usually does not get past the “gatekeeper” and qualify as a trauma. In addition to the exposure to trauma, PTSD requires a certain number of symptoms under the following symptom clusters (abbreviated for this article.): 1) Intrusive Symptoms – nightmares, flashbacks 2) Persistent Avoidance of traumatic stimuli – either internally or as external reminders 3) Negative Alterations of mood or cognition – negative emotions or beliefs, decreased interest in pleasurable activities, decreased ability to experience positive emotions. 4) Alterations in arousal and reactivity – irritability, reckless behavior, insomnia, hypervigilance. These symptoms must be present for over a month and cause significant distress or impairment. The symptoms cannot be due to medications, substances or other illness. Medico-Legal vs. Clinical Diagnosis As a treating doctor, interviewing the patient and learning their own self-report of symptoms could be enough to initiate treatment. However, in a medico-legal setting, I prefer to obtain additional information. Examples include collateral informants such as a family member’s observation of symptoms in a loved one. I also consider medical records, notes from a treating psychiatrist or psychologist, hospital or other records. Information about Interpersonal and occupational functioning can be useful. All of this information is helpful to establish or refute a diagnosis. Diagnostic Criteria – Changes It is worth noting there have been recent changes in the diagnosis in the DSM5 in contrast to the prior edition, the DSM IV. Some online sources reporting information about PTSD may be referring to outdated criteria. People are used to using the internet as a source of medical information but it can be dangerous or misleading if the information is outdated. The DSM5 is the current and most reliable information used by doctors in diagnosing PTSD. The DSM5 is not a reference for the layperson. I recommend conferring with a forensic psychiatrist if PTSD might be relevant in a legal matter. Underdiagnosed and Over diagnosed PTSD As a clinician, I have seen PTSD go undiagnosed among patients who are instead diagnosed with Major Depressive Disorder and various Anxiety disorders. Misdiagnosis ruling out PTSD is a danger of evaluating symptoms in isolation. It is beneficial to a more accurate diagnosis by taking a larger view of all of the symptoms, medical and psychosocial history, and subtler reports from the patient of what they are experiencing. Diagnosis in Litigation As a forensic psychiatric expert witness, I have seen PTSD over-diagnosed, meaning symptoms are diagnosed as PTSD which are better attributable to another psychiatric condition. Litigation following a traumatic event, such as a motor vehicle accident, can create an atmosphere in which symptoms are interpreted somewhat differently than, for example, a busy VA psychiatry clinic. Additionally, it is my experience that the additional time necessary and available when I conduct a forensic evaluation enhances proper diagnosis (versus in a clinic.) The volume and type of data I require to help a treat a patient is different than what is required to inform a fact finder. What other diagnoses are seen with PTSD? In many cases, I will see those with PTSD develop a Mood Disorder such as Major Depressive Disorder or an Anxiety Disorder. It is not rare for an individual with PTSD to develop Alcohol Use Disorder. In cases of a car accident causing PTSD, we could see a Traumatic Brain Injury. It is worth noting that TBI can share some, but not all, symptoms with PTSD. What if my client (a litigant) does not meet criteria for PTSD but is severely affected by the trauma?** There are cases when someone is significantly affected by trauma but does not technically meet DSM5 criteria for PTSD. They could meet the criteria for “Other Specified Trauma/Stressor-Related Disorder”. I recently examined an individual who met all the criteria for PTSD except for having no avoidant behaviors. I must consider other potential diagnoses such as Acute Stress Disorder and Adjustment Disorders which, like Depression and Anxiety Disorders can be confused with PTSD. The Forensic Evaluation Must Not Address Cause and Effect PTSD, in of itself, does not determine a medico-legal opinion. I may diagnose PTSD but the timeline and events I discover in my assessment might indicate it was pre-existing. The presence of PTSD after a trauma does not imply either correlation or causation. The Appropriate Psychiatrist It is my opinion that any diagnosis of PTSD, or ruling out of a diagnosis of PTSD, requires the close review of a trained Forensic Psychiatrist. Medico-legal skill is different from that of a clinical psychiatrist without forensic training. Consulting with a Forensic Psychiatrist Attorneys should consider retaining a Forensic Psychiatrist as a consultant early in the case to advise about diagnoses and symptoms. This can help in evaluating the case and a client’s potential damages. *The Diagnostic and Statistical Manual of Mental Disorders, 5th Ed. Is often referred to as the DSM5. Citation: American Psychiatric Association, DSM-5 Task Force. (2013). Diagnostic and statistical manual of mental disorders: DSM-5™ (5th ed.). Arlington, VA, US: American Psychiatric Publishing, Inc. http://dx.doi.org/10.1176/appi.books.9780890425596 **Attorneys, litigants, even family members may be tempted to interpret symptoms using “common sense” or personal experience. PTSD is complex. It can be masked by other conditions that are also self-diagnosed. The DSM5 criteria for a diagnosis of PTSD likely is different from the “common sense” or general belief of what is PTSD. I suggest attorneys with their own impressions of their client as having PTSD or another psychiatric condition as an indication a Forensic Psychiatrist should be brought in to investigate further.

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  Forensic, Addictions & Correctional Psychiatry and Brain Injury Expert Witness

  Houston, TX

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