Decision-making and risk-taking in forensic and non-forensic patients with schizophrenia spectrum disorders: A multicenter European study.

Studies of patients with schizophrenia and offenders with severe mental disorders decision-making performance have produced mixed findings. In addition, most earlier studies have assessed decision-making skills in offenders or people with mental disorders, separately, thus neglecting the possible additional contribution of a mental disorder on choice patterns in people who offend. This study aimed to fill this gap by comparing risk-taking in patients with schizophrenia spectrum disorders (SSD), with and without a history of serious violent offending assessing whether, and to what extent, risk-taking represents a significant predictor of group membership, controlling for their executive skills, as well as for socio-demographic and clinical characteristics. Overall, 115 patients with a primary diagnosis of SSD were recruited: 74 were forensic patients with a lifetime history of severe interpersonal violence and 41 were patients with SSD without such a history. No significant group differences were observed on psychopathological symptoms severity. Forensic generally displayed lower scores than non-forensic patients in all cognitive subtests of the Brief Assessment of Cognition in Schizophrenia (except for the "token motor" and the "digit sequencing" tasks) and on all the six dimensions of the Cambridge Gambling Task, except for "Deliberation time", in which forensic scored higher than non-forensic patients. "Deliberation time" was also positively, although weakly correlated with "poor impulse control". Identifying those facets of impaired decision-making mostly predicting offenders' behaviour among individuals with mental disorder might inform risk assessment and be targeted in treatment and rehabilitation protocols.

Implementation of the European Psychiatric Association (EPA) guidance on forensic psychiatry in Poland. Current state and required measures. / Implementacja wytycznych Europejskiego Towarzystwa Psychiatrycznego (EPA) w zakresie psychiatrii sadowej w Polsce. Stan obecny i konieczne dzialania.

The article discusses the key aspects of the guidance of the European Psychiatric Association (EPA) on forensic psychiatry and the required actions to implement guidance into clinical practice. The authors pay attention to the discrepancies between the recommendations resulting from the guidance and clinical practice and current systemic solutions. The basic difficulties were discussed in relation to the implementation of the guidelines in the clinical practice in Poland as regards providing services as an expert by psychiatrists and psychologists, risk assessment and management, psychiatric therapy in detention centers, implementation of protection measures in inpatient and outpatient treatment conditions, efficiency of pharmacological and non-pharmacological interventions. We hope that discussing the content of the guidance will help to deepen the knowledge of clinicians in the field of work as court expert witnesses and persons responsible for the implementation of the preventive measure. Based on the clinical experience measures were proposed that enable implementation of the guidance, and thus improvement of the quality of care exercised over the mentally ill criminal offenders.

Psychological factors of aggressive behaviour in patients of forensic psychiatry wards with the diagnosis of schizophrenia.

Scientific research shows that the likelihood of aggressive behaviour in people with mental disorders compared to healthy people is usually higher than among healthy people. Considering the social harmfulness of acts committed by persons suffering from schizophrenia, a thorough analysis of their conditions is recommended. The paper presents the results of research conducted by a team from the Forensic Psychiatry Clinic of the Institute of Psychiatry and Neurology (IPiN) in Warsaw regarding the psychological determinants of aggressive behaviour of people diagnosed with schizophrenia. The analysis covers selected demographic variables, personality traits as well as the level and type of aggression presented, including previously undertaken violent behaviour. This article includes the results of studies on patients diagnosed with schizophrenia, interned in the Forensic Psychiatry Clinic of IPiN, as well as patients with schizophrenia (addicted and non-addicted) staying in general psychiatric wards.

Difficulties to differentiate mood disorders co-occurring with compulsive gambling. Discussion based on a case study. / Trudnosci róznicowania zaburzen nastroju wystepujacych w przebiegu zaburzen uprawiania hazardu. Rozwazania na bazie opisu przypadku.

Contemporary literature does not take a clear position on the issue of determining civil and criminal liability of persons diagnosed with pathological gambling, and all the more so in case of possible comorbidity of or interference with other mental disorders. Diagnostic difficulties are demonstrated by a clinical picture of a patient with problem gambling who underwent forensic and psychiatric assessments to evaluate the process of making informed (and independent) decisions in view of numerous concluded civil law (mainly financial) agreements. The patient had been examined 5 times by expert psychiatrists who, in 4 opinions, diagnosed her with bipolar affective disorder, including 1 diagnosis of rapid cycling of episodes. Based on the current state of scientific knowledge about the relationship between problem gambling and mood disorders, bipolar affective disorder was not confirmed. Diagnostic difficulties, resulting both from diagnostic haziness and unreliable information obtained during patient interview, that emerged in the course of case study point to the need for multi-dimensional clinical diagnosis of persons with suspected mood disorders and behavioral addictions.

Dyadic death - depression and borderline personality.

OBJECTIVES: This work aims to present the difficulties in the assessment of sanity of a perpetrator involved in the so-called dyadic death, which in Poland is identified with the occurrence of sever mood disturbances at the time of the crime. CASE: A case of a man who killed his wife and two children is presented. The perpetrator himself tried to commit suicide by cutting his veins with a razor. COMMENTARY: The authors underline diagnostic difficulties which were encountered in the analysed case, they point out the necessity to go beyond the phenomenological aspect of "dyadic death" and the need for multidimensional clinical evaluation of the perpetrator. The rarity of similar acts and low survival rate of perpetrators leaves experts with relatively small amount of opinion giving experience. Thus, there is a need for high accuracy research and careful consideration.

[Infanticide or murder in a forensic psychiatric assessment. A case study 5-fold infanticide--the search of psychopathology]. / Dzieciobójstwo czy zabójstwo? Studium przypadku 5-krotnego zabójstwa wlasnych dzieci--poszukiwanie psychopatologii.

OBJECTIVE: The difficulties to distinguish between infanticide and murder of the woman own child, experienced by both experts and the court, have been discussed on the example of the psychopathological description of the perpetrator killing five of her children, and data from the literature. CASE: This paper describes an extremely rare case of the woman who has killed five of her children immediately after their birth over several years. COMMENT: It is very difficult to decide whether the seemingly rational motivation to kill her own child shortly after their birth can be a proof of specific psychopathological state which is a consequence of childbirth or an assassination planned in cold blood. The act of killing a child by their own mother is so contrary to nature that it seems easy to find the ground for psychosis or a state of emergency. However, when neither of them has been proven the experts are left with the conviction of both diagnostic deficiency and inexplicability of human behaviour.

[Münchausen syndrome by proxy in a forensic psychiatric evaluation--the description of a case and ethical controversy]. / Przeniesiony zespól Münchausena w opinii sadowo- -psychiatrycznej--opis przypadku i kontrowersje etyczne.

AIM: Presentation of the difficulties in diagnosing Münchausen syndrome by proxy. METHOD: Comparison of four different conclusions in forensic psychiatric opinions issued in one case, due to the need of answering to the questions of the court, in what periods and why was the deterioration of the child's health, in connection with an allegation that the mother has acted to his detriment. In the first medical-legal opinion the treating physician, while being the head of the ward and the person informing the police of the action against a child by the mother, recognised Münchausen syndrome by proxy. The second opinion was delivered by a psychologist, who stated that the mother distinguished the introspective attitude characterised by excessive, exaggerated accuracy, thoroughness, and did not give a unambiguous answer to the questions of the court. In the third opinion the experts accepted that the functioning of the subject does not create a threat to life and health of the child. The fourth opinion developed by the authors of this paper noted that in the analysed medical records of the childs' hospitalisation, no arguments were found to recognise Münchausen syndrome by proxy. RESULTS. In the conducted extended ambulant study of the subject and the analysis of the medical documentation of the 31 hospitalisations of the child showed that the improvement of the child's health was not associated in exclusion of pushing aside the mother from the child, but was the result of the consistency of the therapeutic treatment team, the continuation and the modification of the treatment. CONCLUSIONS: In appointing the expert, the art. 196 of the Code of Criminal Procedure should be considered, which states that the expert should not be the treating doctor, because his opinion loses value impartiality. Diagnosis of Münchausen Syndrome by proxy itself stirs up numerous controversies..

[A psychopathological picture of the perpetrator of violence in a family]. / Obraz psychopatologiczny sprawcy przemocy w rodzinie.

Violence is a very frequent subject in contemporary literature. It appears that the reason for this is its spreading and a negative social perception of this phenomenon. The present article provides an analysis of definitions, forms and conditionings of violence, but, most of all, a review of results of the research focused on characteristics of the perpetrator of delinquent actions within the family. In order to summarize, it should be stated that literature on the subject is dominated with a theoretical discourse, based on remarks and experiences of other authors. What is lacking, is a wide spectrum scientific research. The present article constitutes a theoretical basis for a research programme aiming for a detailed description of perpetrators of crimes against the family in a psychosocial, medical and judicial context. It will contribute to a better understanding of the issue and will allow the verification of numerous theoretical opinions on the subject.