Introduction to special issue on social media for forensic mental evaluations.

This special issue of Behavioral Sciences & the Law presents six articles that focus on various issues related to social media in forensic mental health evaluations. These eclectic articles provide updated information about social media's use and navigating difficult ethical concerns. Ranging from violence risk assessment to disability evaluations, the up-to-date information in this special issue allows the forensic evaluator to be more prepared when they inevitably encounter information from social media. As social media continues to grow, both in terms of overall use and the number of available platforms, forensic clinicians will need to remain cognizant of the ways these data can be appropriately utilized as collateral data.

DSM-5-TR diagnosis as a guide to suicide risk assessment.

A specific mental disorder can itself constitute a risk factor for a completed suicide. Even more important, the disorder is typically a modifiable risk factor which informs its own treatment. Recent editions of the DSM have included "suicide subsections" for specific mental disorders and conditions in which the risks of suicidal thoughts and behaviors for the disorder are noted in the literature. The DSM-5-TR can therefore serve as a compendium to be referred to for initial guidance as to whether a specific disorder could contribute to the risk. Adding completed suicides and suicide attempts, also addressed in these subsections, the sections were examined individually for the four parameters of suicidality. Accordingly, the four parameters of suicidality examined here are: suicide, suicidal thoughts, suicidal behavior, and suicide attempts. After providing interpretive comments for each, the parameters for all disorders with a suicide subsection were tabulated for ease of reference. Because specific medical disorders are also associated with elevated rates of suicide, these disorders and the supporting research are tabulated and briefly acknowledged. Allowing for the limitations of the suicide subsections and their analysis, this exegesis is proposed to contribute to training in risk assessment for forensic psychiatry and psychology fellows and to highlight the potential referential value of the DSM-5-TR's suicide subsections for clinical practitioners and those who pursue research on suicide.

Forensic psychiatric evaluation of 187 homicidal assailants with and without a schizophrenia spectrum disorder: Clinical, criminological and behavioral characteristics.

Intentional homicide, a declining phenomenon in Italy, represents one of the most extreme forms of violence. A specific subgroup of homicidal assailants is represented by those affected by mental disorders, where the relationship between psychopathology and characteristics of the homicidal attack is not yet fully understood. We analyzed the case files of 187 homicides or attempted homicides, in which the defendant had undergone a forensic psychiatric evaluation within the previous 10 years from a single forensic psychiatric center. We described and analyzed the perpetrator, victim and criminological characteristics of the study cases. A diagnosis of a schizophrenia spectrum disorder, a victim who was the perpetrator's biological child and absence of a personality disorder diagnosis were associated with an increased probability of having been adjudicated as lacking or having substantially diminished criminal responsibility due to a mental disorder. Homicidal assailants with a schizophrenia spectrum disorder showed some differences in criminological characteristics compared with murderers without a schizophrenic spectrum disorder, including a higher incidence of parricide, interruption of pharmacotherapy before the crime and disorganized post-crime behavior.

Women and men of mafia between traditional cultural contexts and new social roles.

The Italian mafia organizations represent a subculture with values, beliefs, and goals that are antithetical to and undermining of the predominant society. The conduct of individual members includes such extreme violence for material gain, it may at least superficially suggest a severe personality disorder. Since the first edition of the DSM and into the 21st century, various terms have been used, sometimes interchangeably, but over time inconsistently, to designate the mentality and practices of mafia members. Only recently has the psychology of mafia members become a focus of serious scientific study. For the first time, investigators for the present study applied instruments, including the PCL-R, to examine for character psychopathology and specifically degrees of psychopathy in male and female mafia members, 20 female and 21 male members. Results showed some gender difference with the women having a higher score on Factor 1, in contrast to men who showed a lower score. Psychopathy and personality disorder were not found to be associated with membership in the mafia for either gender. Some psychopathic traits and gender differences warrant further research. Meanwhile these findings are consistent with a mentality characterized by beliefs and practices determined by a deviant culture rather than psychopathology.

The question of sanity restoration in jail.

Severe mental illness, especially psychotic disorders that are worsening, acute or complicated, normally require intensive psychiatric care and treatment that is most appropriately provided in a mental hospital. For criminal defendants, transfer to a forensic security hospital has traditionally been the means of achieving hospital care for mentally disordered defendants who have been found incompetent to stand trial or not guilty by reason of insanity. In recent years, with the shortage of intermediate and long-term hospital beds in the United States, including forensic security hospital beds, jail-based competency restoration programs are being established, seemingly obviating hospital transfer. Potential advantages of and concerns about jail-based, as opposed to hospital-based, competency restoration programs are discussed in the literature. If defendants with severe mental illness traditionally treated in a forensic security hospital for competency restoration are now treated for competency restoration in jail, it is not inconceivable that insanity acquittees could one day be treated in jail for sanity restoration. With the premise that it is better to consider the potential consequences before this becomes a serious proposal and is implemented, this analysis examine the advantages and concerns that have been put forth for jail-based competence restoration programs as they may or may not apply to jail-based sanity restoration programs. Substantial commonality is recognized, but also some differences, as well as reason for skepticism of the purported virtues of either alternative to care and treatment in forensic security hospitals.

Gender differences in combined homicide-suicide with consideration of female terrorist bombers.

Combined homicide-suicide (H-S) is a phenomenon described as an offender committing a homicidal act followed by their suicide. Current literature on H-S is dominated by a focus on men and their particular set of motivations and actions, primarily because females constitute only a small fraction of the cases of completed H-S. This review begins by analyzing this data and integrating females within two subclassifications of H-S: the psychopathology of the actor (or perpetrator), and the actor's relationship to her homicide victims. Within the relational subcategory of H-S, females are: (1) underrepresented when victims are their spouses or intimate partners (consortial H-S); (2) more prevalent when victims are their own children (filial H-S); and (3) with rare exceptions, not represented in extrafamilial, adversarial and pseudo-commando H-S perpetrators. This review includes female bombers in this gender comparison.

Psychopathy in Italian female murderers.

Over the years, the number of homicides in Italy has progressively decreased, ultimately becoming one of the lowest rates in Europe (357 = 0.7 per 100,000 inhabitants in 2017, according to ISTAT). The number of homicides committed by women was about 9% of the total number of homicides during our study period. The percentage has increased in recent years because the total number of homicides has decreased without a proportionate decrease in the number of female homicides. Indeed, murder is an unusual type of crime for a woman and is often associated with a mental disorder, so when a woman committed a homicide, a psychiatric assessment was often performed. A forensic psychiatry expert was assigned to investigate the offender's psychopathology and mental state at the time of the offense. The root causes of the crime remained unexplained, however, due to the lack of a psychiatric precedent to justify this kind of assessment. The role of psychopathy in homicide has seldom been studied in female offenders, even though psychopathy has an important role in violent crimes. The investigators examined, clinically and historically, a sample of women who committed murder with different levels of criminal responsibility (female homicide offenders found not guilty by reason of insanity, having partial criminal responsibility, and convicted as criminally responsible and sentenced to prison) to identify the prevalence of the psychopathic dimension and its possible role in this sample. Prevalence and degree of psychopathic traits were examined in these female offenders using the Psychopathy Checklist-Revised. This study showed that females who had committed homicide were likely to suffer from mental illness; most of the homicidal acts were committed impulsively; and most female homicides occurred within the family, especially among women who were psychotic, but less so if they were psychopathic. Psychopathy tended to co-occur more with personality disorders than with psychotic psychopathology. Psychopathy was more evident among female homicide offenders who had been abused or traumatized. Psychopathic women who killed had high factor F1 scores and low antisocial component of factor F2.

Females who maltreat animals.

Studies of animal maltreatment and of untoward or abnormal aggression predominantly involve male subjects, raising the question as to whether females who engage in such behaviors are like, or fundamentally different than, their male counterparts. Inquiry to address this issue could pertain to gender similarities and differences; moreover, it could provide greater understanding of the behavior itself, in this case, animal maltreatment. Of the various patterns of animal maltreatment in the literature, there are enough studies with gender addressed to allow some observations on two patterns: animal cruelty in childhood and animal hoarding. Animal cruelty among girls may be more common than is widely assumed, but substantial recurrent cruelty appears, as expected, to be more common among males and is consistent with conduct disorder occurring more frequently among boys. Females, especially older females who live alone, predominate among animal hoarders, whose psychology is altogether different from those who engage in antisocial cruelty. The potential significance of these observations is discussed within the contexts of developmental and gender psychology.

Closing Italian Forensic Psychiatry Hospitals in Favor of Treating Insanity Acquittees in the Community.

Originally a hedge against the death penalty, the insanity defense came to offer hospitalization as an alternative to imprisonment. In the late 19th century Italy opened inpatient services first for mentally ill prisoners and then for offenders found not guilty by reason of insanity. Within the past decade, a series of decrees has resulted in transferring the responsibility for treating NGRI acquittees and "dangerous" mentally ill prisoners from the Department of Justice to the Department of Health, and their treatment from Italy's high security forensic psychiatric hospitals (OPGs) to community regional facilities (REMSs, Residences for the Execution of Security Measures), community mental health facilities, one of which is located in each region of Italy. Today community REMSs provide the treatment and management of socially dangerous offenders. The dynamic evolution of Italy's progressive mental health system for insanity acquittees, to our knowledge the most libertarian, community oriented approach of any country, is retraced. Discussion includes cautionary concerns as well as potential opportunities for improvements in mental health services. Copyright © 2016 John Wiley & Sons, Ltd.

The appropriateness of treating psychopathic disorders.

The received wisdom is that there is no known effective treatment for psychopathic disorders. Although outcome studies have not identified an effective programmatic treatment for psychopathic disorders, such studies tend to leave the question open. If behavioral science has not established that psychopathic disorders respond to a particular programmatic approach, neither are psychopathic disorders convincingly proven to be absolutely resistant to treatment. If no treatment is known to be effective in psychopathic disorders, then any treatment seems to squander resources. What is often missing from the discussion is effective therapeutic measures to treat other behaviors that often co-occur, if they do not represent a domain of pathology of psychopathic disorders, such as impulsive aggression. After a brief summary of results of programmatic treatment of psychopathic offenders, this review focuses on the pharmacotherapy of impulsive aggression in psychopathic disorders. If the impulsive aggression that occurs with psychopathic disorders can be better controlled, treatment can have substantial benefits and would be most appropriate.

Guns, Mental Illness, and the Law: Introduction to This Issue.

Firearm violence is a top-tier public health problem in the U.S., killing 33,563 and injuring an additional 81,396 people in 2012 (Centers for Disease Control and Prevention, CDC, ). Given constitutional protection and the cultural entrenchment of private gun ownership in the U.S., it is likely that guns will remain widely accessible--and largely unrestricted--for the foreseeable future. Therefore, most policies and laws intended to reduce firearm violence focus selectively on preventing "dangerous people" from having access to guns. That is a formidable challenge. How do we think productively about guns and mental illness in this context, and about the role of law in lessening the toll of gun violence?