Análisis sociodemográfico, metodológico y diagnóstico de los informes periciales en psiquiatría y psicología para la toma de decisiones legales en el Centro de Estudios en Derecho y Salud (Medellín, Colombia) / Socio-demographic, methodological and diagnostic analysis of expert reports in psychiatry and psychology for legal decision-making Centro de Estudios en Derecho y Salud (Medellín, Colombia) / Análise sociodemográfica, metodológica e diagnóstica de relatórios de especialistas em psiquiatria e psicologia para tomada de decisões legais no Centro de Estudios en Derecho y Salud (Medellín, Colombia)

El objetivo del presente estudio fue analizar las características sociodemográficas, metodológicas y diagnósticas de los informes periciales en psiquiatría y psicología realizados en el Centro de Estudios en Derecho y Salud entre 2011 y 2020. Se optó por un enfoque cuantitativo, descriptivo con intención analítica, transversal, con diseño retrospectivo. Se analizó la información obtenida en 145 peritajes. Se adelantó un análisis univariado para todas las variables sociodemográficas, metodológicas y diagnósticas de los informes periciales, según su naturaleza cualitativa o cuantitativa, y un análisis bivariado a través de tablas de contingencia para las variables mencionadas, con intervalos de confianza del 95 % para cada una de las medidas de prevalencia. Se encontró que la mayoría de peritajes fueron solicitados por el área del derecho contencioso-administrativo. Los diagnósticos más prevalentes fueron el trastorno adaptativo, el trastorno por estrés postraumático y el trastorno depresivo. Si bien los informes revisados cumplen con los lineamientos mínimos de ley, se encontraron algunas falencias relacionadas con la ausencia de información. Se espera que estos hallazgos permitan la reflexión por parte de los auxiliares de la justicia sobre los requerimientos de los informes periciales con miras a la humanización de la justicia y el apoyo a la toma de decisiones legales.

The aim of this study was to analyse the socio-demographic, methodological and diagnostic characteristics of the expert reports in psychiatry and psychology carried out at the Centre for Law and Health Studies between 2011 and 2020. We opted for a quantitative, descriptive approach with analytical, cross-sectional, retrospective design. The information obtained from 145 expert opinions was analysed. A univariate analysis was carried out for all sociodemographic, methodological and diagnostic variables in the expert reports, according to their qualitative or quantitative nature, and a bivariate analysis through contingency tables for the aforementioned variables, with confidence intervals of 95 % for each of the prevalence measures. It was found that the majority of expert opinions were requested by the area of contentious-administrative law. The most prevalent diagnoses were adjustment disorder, post-traumatic stress disorder and depressive disorder. Although the reports reviewed comply with the minimum legal guidelines, there were some shortcomings related to the absence of information. It is hoped that these findings will allow for reflection on the part of justice officials on the requirements of expert reports with a view to the humanisation of justice and support for legal decision-making.

O objetivo deste estudo foi analisar as características sociodemográficas, metodológicas e diagnósticas dos laudos periciais em psiquiatria e psicologia realizados no Centro de Estudos em Direito e Saúde entre 2011 e 2020. Optou-se por uma abordagem quantitativa e descritiva com desenho analítico, transversal e retrospectivo. Foram analisadas as informações obtidas de 145 pareceres de especialistas. Foi realizada uma análise univariada para todas as variáveis sociodemográficas, metodológicas e diagnósticas dos laudos periciais, de acordo com sua natureza qualitativa ou quantitativa, e uma análise bivariada por meio de tabelas de contingência para as variáveis mencionadas, com intervalos de confiança de 95 % para cada uma das medidas de prevalência. Verificou-se que a maioria dos pareceres foi solicitada pela área de direito contencioso-administrativo. Os diagnósticos mais prevalentes foram transtorno de ajustamento, transtorno de estresse pós-traumático e transtorno depressivo. Embora os relatórios analisados estejam em conformidade com as diretrizes legais mínimas, houve algumas deficiências relacionadas à ausência de informações. Espera-se que esses resultados permitam uma reflexão por parte dos envolvidos no sistema judiciário sobre os requisitos dos laudos periciais, com vistas à humanização da justiça e ao apoio à tomada de decisões legais.

Nuevas demandas ejecutorias y periciales para la salud pública en la reforma penal cubana de 2022 / New Executive and Judicial Expert Demands for Public Health in 2022 Cuban Penal Reform

Introducción: Durante 2022 ocurrió la reforma del sistema penal cubano, materializada en tres nuevas leyes básicas: Código Penal y las del proceso y la ejecución penales. Ello demandó respuestas organizativas del Ministerio de Salud Pública cubano, en especial por la ampliación de tipos de aseguramiento penal terapéutico a adictos e inimputables en unidades de salud y de las tareas periciales. Objetivo: Identificar las demandas para el sistema de salud en las nuevas leyes penales, en especial para la salud mental. Posición: Desde propuestas previas al proceso legislativo y la asesoría durante este, se visionó precozmente la necesidad de nuevas regulaciones para las interdependientes actividades periciales y asistenciales de respuesta del sistema de salud a la reforma penal. Fomentar anticipadamente el intercambio académico entre derecho penal y psiquiatría, favoreció la sinergia intersectorial, asumir la asesoría al proceso legislativo y elaborar, en corto plazo, propuestas normativas sólidas al sistema de salud, acordes a sus objetivos y estructura. Metodológicamente fueron oportunas las consultas a expertos. Conclusiones: Se considera que el vínculo intencionado previo entre sistemas de salud y penal favorece que las propuestas legislativas tengan una base más científica y una respuesta organizativa, más eficiente y sinérgica desde el sistema de salud a las demandas identificadas en nuevas leyes penales(AU)

Introduction: During 2022, the reform of the Cuban penal system occurred, which materialized in three new basic laws: The Penal Code, Penal Procedures Law and Penal Execution Law. This reform demanded organizational responses from the Cuban Ministry of Public Health in those tasks for health units and judicial expert, especially the expansion of types of therapeutic penal coverage to addicts and those who cannot be held accountable. Objective: To identify the demands of the health system in the new criminal laws, especially for mental health. Position: Beginning with the previous proposals to the legislative reform and counselling, the need for new regulations for the interdependent expert and assistance activities of the health system that respond to the penal reform was timely envisioned. The early promotion of academic exchange between the penal law and psychiatry favored intersectoral synergy, advice to the legislative process and the development, in the short term, of solid regulatory proposals for the health system, in accordance with its objectives and structure. Methodologically, consultations with experts were appropriate. Conclusions: It is considered that the previous intentional relationship between health and criminal systems favors that the legislative proposals have more scientific basis beside an organizational, more efficient and synergistic response from the health system to the demands identified in new criminal laws(AU)

Criminological Characteristics and Criminal Responsibility Capacity of Offenders with Alcoholism / 中山大学学报(医学科学版)

ObjectiveTo analyze the criminal behavior characteristics of alcohol-related crime offenders and explore the relationship between criminal behavior characteristics and criminal responsibility capacity. MethodsBasic information， alcohol use information， psychiatric symptoms before and after the crime， criminological behavioral characteristics and conclusion of judicial evaluation were collected. ResultsThe drinking history of the chronic alcoholism group 25.0 （13.3~30.0） years was significantly longer than that of the acute alcoholism group 1.2 （0~14.3） years. In the chronic alcoholism group， 85.0% drank alcohol at least once a day， 52.5% had morning or bedtime drinking habits， and 92.5% drank mainly alone. Violent crimes accounted for 57.6%. Delirium existed in 52.5% of the chronic alcoholics' mental state at the time of the crime， and 84.6% of the acute alcoholics' mental state was hazy. In the chronic alcoholism group， 42.5% committed the crime with pathological motive， and in the acute alcoholism group， 69.2% committed the crime with realistic motive. Acute alcoholism group 96.2% were assessed as complete criminal responsibility capacity， and chronic alcoholism group 50.0% were assessed as complete criminal responsibility capacity. ConclusionCompared with acute alcoholism offenders， chronic alcoholics had a longer drinking duration， more frequency drinking， and obvious morning drinking or bedtime drinking habits. The nature of alcoholism crime cases was mostly violent. Compared with the chronic alcoholism group， the acute alcoholism group had highly selective motives for committing crimes and were mostly rated as complete criminally responsibility.

Research Progress and Application Prospect of Facial Micro-Expression Analysis in Forensic Psychiatry / 法医学杂志

Research on facial micro-expression analysis has been going on for decades. Micro-expression can reflect the true emotions of individuals, and it has important application value in assisting auxiliary diagnosis and disease monitoring of mental disorders. In recent years, the development of artificial intelligence and big data technology has made the automatic recognition of micro-expressions possible, which will make micro-expression analysis more convenient and more widely used. This paper reviews the development of facial micro-expression analysis and its application in forensic psychiatry, to look into further application prospects and development direction.

A perícia psiquiátrica no processo penal da pessoa com transtorno mental em conflito com a lei: uma análise sob a luz da sociologia das ausências / The psychiatric expertise in criminal proceedings of the person with a mental disorder in conflict with the law: an analysis in the light of the sociology of absences

A pessoa com transtorno mental que comete delito pode ter a pena substituída por medida de segurança, se confirmado por laudo psiquiátrico forense que no momento do crime não tinha discernimento sobre a ilicitude do fato, conforme Código Penal brasileiro. Essa medida de segurança pode ser internação em Hospital de Custódia e Tratamento Psiquiátrico ou tratamento ambulatorial. Não existe limite de prazo para cumprimento dessa medida, e aquele que é custodiado à internação não tem prazo para deixar esse hospital. A perícia psiquiátrica forense tem grande influência na decisão judicial, pois o perito que conclui sobre a imputabilidade penal, com base no método biopsicológico, avaliação do nexo de causalidade entre transtorno mental e delito, e da periculosidade do indivíduo. Essa pessoa acaba por ser duplamente estigmatizada, pelo transtorno mental e pelo crime cometido, e por ser silenciada, tornando-se socialmente invisível. Este estudo apresenta como objetivo descrever como ocorre a perícia psiquiátrica no processo penal e seus desdobramentos para a aplicação da medida de segurança, identificando as características apresentadas nos laudos forenses e as situações de invisibilidade das pessoas com transtorno mental que cometeram delitos. Trata-se de pesquisa qualitativa descritiva com análise documental, tendo como fonte primária os laudos psiquiátricos. O percurso metodológico não é restrito, segue processo de "garimpagem" que foi dividido em 3 etapas: identificação e coleta de documentos; organização do material coletado; procedimento da análise documental. Ao final foram selecionados 37 laudos. Os resultados foram classificados em 4 categorias: categoria tempo da perícia identificou diversos fatores que envolvem o decurso de tempos relacionado ao exame pericial, dentre eles, 5 perícias realizadas após 365 dias do delito; na categoria sociodemográfica, o perfil dos periciandos eram, na maioria, do sexo masculino, solteiros, brancos, sem filhos, idade até 40 anos, muitos sequer concluíram o ensino fundamental e exerciam profissões que exigem pouca ou nenhuma qualificação técnica e educação; na categoria saúde mental, prevaleceu a indicação de preexistência de transtorno mental ao delito e a maioria dos periciandos já fez tratamento psiquiátrico, incluindo internação, sendo comum a descontinuidade do tratamento; na categoria conclusão pericial, a maioria dos periciandos foram considerados imputáveis, o tratamento ambulatorial foi o mais indicado, e apresentou prevalência de crimes contra patrimônio. Os resultados foram discutidos com dados encontrados na literatura e com base no marco teórico da Sociologia das Ausências. Identificou-se a produção de não existência dos periciandos sob as formas de inferior, improdutivo e ignorante, por meio das monoculturas da naturalização das diferenças, dos critérios de produtividade capitalista e dos saber e do rigor do saber, respectivamente. É necessário desconstruir essas monoculturas e substituí-las pelas ecologias dos reconhecimentos, da produtividade e de saberes, respectivamente. Tanto a perícia quanto os laudos precisam ser descontruídos e reconstruídos sob novos olhares de saberes científicos [psiquiatria e direito] e saberes não científicos, para que a não existência dessas pessoas não seja produzida

A person with a mental disorder who commits a crime may have the sentence replaced as a security measure, if confirmed by a forensic psychiatric report that, at the time of the crime, they had no discernment about the illegality of the fact, according to the Brazilian Penal Code. This security measure can be hospitalisation in a Hospital of Custody and Psychiatric Treatment or outpatient treatment. There is no deadline for compliance with this measure, and those who are compulsorily hospitalised have no deadline to leave that hospital. Forensic psychiatric expertise has a great influence on the decision of the judge, as the expert who concludes on criminal responsibility, based on the biopsychological method, assessment of the causal link between mental disorder and the crime committed, and dangerousness. This person ends up being doubly stigmatized, due to the mental disorder and the crime committed, and for being silenced, becoming socially invisible. This study aims to describe how psychiatric expertise occurs in the criminal process and its consequences for the application of the security measure, identifying the characteristics presented in the forensic reports and the situations of invisibility of people with mental disorders who have committed crimes. This is descriptive qualitative research with documental analysis, having psychiatric reports as a primary source. The methodological course is not restricted and it follows a "mining" process, which was divided into 3 stages: identification and document collection; organization of the material collected; document analysis procedure. In the end, 37 reports were selected. The results were classified into 4 categories: time of expertise category, identified several factors that involve the time course related to the expert examination, among them, 5 psychiatric expertise took place after 365 days of the crime; in the sociodemographic category, the profile of examinees was mostly male, single, white, without children, and aged up to 40 years old, many of them had not even completed elementary school and worked in professions that require little or no technical qualification and education; in the mental health category, the indication of a pre-existing mental disorder to the crime prevailed and most of the examinees had already undergone psychiatric treatment, including hospitalisation, with discontinuity of treatment being common; in the expert conclusion category, most examinees were considered imputable, outpatient treatment was the most indicated and showed a prevalence of crimes against property. The results were discussed with data found in the literature and based on the theoretical reference of the Sociology of Absences. The production of the non-existence of the examinees in the forms of inferior, unproductive, and ignorant was identified, through the monocultures of the naturalization of differences, the criteria of capitalist productivity and knowledge and the rigor of knowledge, respectively. It is necessary to deconstruct these monocultures and replace them with ecologies of recognition, productivity, and knowledge, respectively. Both the expertise and the reports need to be deconstructed and reconstructed under new perspectives of scientific knowledge [psychiatry and law] and non-scientific knowledge so that the non-existence of these people is not produced

Perspectivas éticas e legais em perícias de psiquiatria forense / Ethical and legal perspectives of forensic psychiatry in expert testimony / Perspectivas éticas y legales en pericias de psiquiatría forense

Resumo Conhecer o paradigma ético que fundamenta o código moral da medicina é fundamental para atuar não só na assistência, mas também em processo pericial. A partir de revisão da literatura, propõe-se avaliar a maneira como os quatro princípios éticos fundamentais (beneficência, não maleficência, autonomia e justiça) se aplicam antes, durante e após a perícia psiquiátrica, como perito ou como assistente técnico. Novos desafios éticos vêm surgindo na psiquiatria forense. Com a pandemia de covid-19, a tecnologia foi adotada para permitir a prática da telemedicina, mas ainda se debate se seria suficiente para promover avaliação pericial psiquiátrica adequada. Considerando a complexidade da área, cada situação deve ser analisada de forma individual e abrangente, sendo recomendável buscar auxílio para debater as perspectivas éticas e legais das perícias psiquiátricas quando necessário.

Abstract Knowing the ethical paradigm that bases the medicine moral code is fundamental to act not only in care but also in the expert testimony process. From a revision of the literature, we propose to evaluate the way the four fundamental ethical principles (beneficence, nonmaleficence, autonomy, and justice) apply before, during, and after the psychiatric expert testimony, be it as expert or as technical assistant. New ethical challenges have been appearing in forensic psychiatry. With the COVID-19 pandemic, technology was adopted to allow the practice of telemedicine, but debates still occur if that would suffice for an adequate psychiatric expert testimony evaluation. Considering the complexity of the area, each situation must be analyzed in an individualized and all-encompassing way and seeking help to debate the ethical and legal perspectives of psychiatric expert testimonies is recommended when necessary.

Resumen Conocer el paradigma ético que subyace en el código moral de la medicina es fundamental para actuar no solo en la asistencia, sino también en el proceso pericial. A partir de una revisión bibliográfica, se propone evaluar cómo se aplican los cuatro principios éticos fundamentales (beneficencia, no maleficencia, autonomía y justicia) antes, durante y después de la pericia psiquiátrica, ya sea como perito o como asistente técnico. Están surgiendo nuevos desafíos éticos en la psiquiatría forense. Con la pandemia del Covid-19, se utilizó la tecnología para permitir la práctica de la telemedicina, pero aún está en debate si esto es suficiente para promover una adecuada evaluación psiquiátrica forense. Considerando la complejidad del área, se debe analizar cada situación de manera individual e integral y, cuando sea necesario, buscar ayuda para debatir las perspectivas éticas y legales de la pericia psiquiátrica.

An Epidemiologic Survey and Violent Behavior Analysis of Antisocial Personality Disorder in Young Men in Chengdu / 法医学杂志

OBJECTIVES@#To investigate the epidemiological characteristics of antisocial personality disorder (ASPD) in young men in Chengdu and explore the characteristics and risks of violence.@*METHODS@#Stratified random sampling was used to conduct a self-assessment questionnaire survey in 4 108 males aged from 18 to 34 in Chengdu, including general demographic characteristics, structured clinical interview for the diagnostic and statistical manual of mental disorders-Ⅳ axis Ⅱ disorders (SCID-Ⅱ) personality disorder screen questionnaire, violence questionnaire, psychosis screening questionnaire (PSQ), Alcohol Use Disorders Identification Test (AUDIT) and drug use. χ2 test, univariate and multivariate logistic regression were used for analysis and odds ratio (OR) was calculated.@*RESULTS@#The positive rate of ASPD was 5.91%, which was associated with young age, unmarried, unemployment state, low educational level, violent behavior, psychotic symptoms, alcohol and drug use (P<0.05). Young men with ASPD also had a risk (P<0.05) of violence (OR was 8.51), multiple violence (OR was 16.57), injury (OR was 6.68), intentional violence (OR was 11.41), etc., the risk decreased after controlling for psychotic symptoms and substance abuse, but was still statistically significant.@*CONCLUSIONS@#The risk of violence, severe violence and intentional violence in young men in Chengdu is high, and psychotic symptoms and substance abuse increase the risk of ASPD violence and relate characteristics.

The Legal Correspondence of Sexual Self-Defense Capability Assessment / 法医学杂志

OBJECTIVES@#To understand the legal application and case deposition of assessment opinions of sexual self-defense capability, and to explore the necessity of legal correspondence in the sexual defense capability assessment.@*METHODS@#According to the self-made questionnaire, the cases of sexual self-defense capability assessment completed by the Academy of Forensic Science from January 1, 2012 to December 31, 2018 were statistically analyzed through telephone interviews and referrals.@*RESULTS@#Among the 69 cases, 3 cases (4.3%) had complete sexual self-defense capability, 30 cases (43.5%) had weakened sexual self-defense capability, 32 cases (46.2%) had no sexual self-defense capability, and 4 cases (5.8%) were not suitable for assessment. Among the 30 cases with weakened sexual self-defense ability, 15 cases were filed and investigated by public security authorities for rape and 15 cases were not. The inconsistent rate of disposition was 1∶1. Among the 15 rape cases filed and investigated by the public security authorities, 10 cases were arrested and prosecuted by the procuratorate and sentenced to fixed-term imprisonment by the court, while the other 5 cases were not arrested and prosecuted by the procuratorate, with an inconsistent rate of disposition being 2∶1.@*CONCLUSIONS@#The legal application of the assessment opinion on the weakening of sexual self-defense capability is inconsistent, and the judicial disposition is confusing. It is imperative to unify and correspond the classification of sexual self-defense capability with the legal requirements.

Application Prospect of Integrative Omics in Forensic Identification of Methamphetamine-Associated Psychosis / 法医学杂志

The clinical symptoms and signs of methamphetamine-associated psychosis (MAP) and schizophrenia are highly similar, but the situation is completely different when MAP and schizophrenia patients need to be assessed for criminal responsibility after they comitted a harmful behavior. Therefore, the distinction between the two psychoses is very important in forensic psychiatry. At present, the identification of these two psychoses is mainly dependent on the corresponding criteria such as the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the Chinese Classification of Mental Disorders Version 3 (CCMD-3). It's challenging to diagnose and distinguish between the two in practical cases due to their similar clinical symptoms and the lack of effective objective indexes. Different from the limitations of single omics, integrative omics intergrates data from multiple dimensions and has been extensively studied in the field of schizophrenia and has achieved some preliminary results. In view of the correlation between MAP and schizophrenia and the potential application value of integrative omics, this paper proposes an integrative omics strategy for MAP pathogenesis and forensic identification, aiming to improve the further understanding of the relationship between the two psychoses and the corresponding pathogenesis. It also provides references for the future exploration of integrative omics in forensic precise identification and effective monitoring and early warning methods.

Progress of Keystroke Dynamics in Deception Research / 法医学杂志

Traditional polygraph techniques mostly rely on the changes of an individual's physiological indicators, such as electrodermal activity, heart rate, breath, eye movement and function of neural signals and other indicators. They are easily affected by individual physical conditions, counter-tests, external environment and other aspects, and it is difficult to conduct large-scale screening tests based on the traditional polygraph techniques. The application of keystroke dynamics to polygraph can overcome the shortcomings of the traditional polygraph techniques to a large extend, increase the reliability of polygraph results and promote the validity of legal evidence of polygraph results in forensic practice. This paper introduces keystroke dynamics and its application in deception research. Compared with the traditional polygraph techniques, keystroke dynamics can be used with a relatively wider application range, not only for deception research but also for identity identification, network screening and other large-scale tests. At the same time, the development direction of keystroke dynamics in the field of polygraph is prospected.

Analysis on mental-insanity and cessation-of-dangerousness examinations in three Brazilian custodial institutions: a retrospective cross-sectional study

ABSTRACT BACKGROUND: In Brazil, the right to healthcare and the incorporation of best scientific evidence in public health are universally guaranteed by law. However, the treatment offered to patients with mental disorders in custodial hospitals in this country has not been rigorously evaluated. OBJECTIVES: To analyze the psychiatric diagnoses and treatments implemented in three Brazilian custodial institutions. DESIGN AND SETTING: This was a retrospective, cross-sectional and descriptive study on patients held in custody in three Brazilian institutions, as judicially-determined safety measures due to their mental disorders, and the tools used in diagnoses and treatments. These institutions are in Rio de Janeiro and the Federal District. METHODS: The data from medical and judicial records that were made available were assessed regarding the diagnoses that were made and the instruments that were used. RESULTS: None of these inpatients were evaluated using validated tools, and only a few medical records presented clear descriptions of the cases. No patient with substance involvement had undergone laboratory toxicological assays. It was not possible to verify the adequacy of treatments because the procedures were inadequately described in the records. CONCLUSIONS: No standardized protocols or instruments for diagnosing mental health disorders or assessing use of psychoactive substances had been applied among the inpatients at these custodial institutions in Rio de Janeiro and the Federal District. The treatments that were prescribed to these inpatients consisted mainly of drugs.

Forensic Analysis of 105 Autopsy Cases of Psychiatric Patients / 法医学杂志

Objective To provide reference for medical and health services and forensic expertise, the causes and manners of death of psychiatric patients were analyzed retrospectively. Methods A total of 105 autopsy cases of psychiatric patients accepted and settled by Institute of Forensic Science of Criminal Investigation Police University of China from 2004 to 2019 were collected. The cases were divided into four groups： disease death, suicidal death, accidental death and homicidal death. The common causes of death of each group were statistically analyzed and the differences in age, disease duration, body mass index （BMI） and gender among the groups were assessed. Results Of the 105 cases, 60 were male and 45 were female, the course of psychosis was （12.9±10.4） years, the age of the deceased was （51.3±11.4） years, and 61.0% was schizophrenic. There were 50 cases （47.6%） in the disease death group, in which the psychiatric patients were the oldest and had the longest course of psychosis and lowest BMI. Pulmonary thromboembolism, respiratory infections, and cardiogenic disease were the most common causes of death in the group. There were 26 accidental deaths （24.8%）, among which traffic accidents were the most common cause of death. There were 15 homicidal deaths （14.3%）, all of which were male, with craniocerebral injury being the most common cause of death. There were 14 suicidal deaths （13.3%）. In suicidal death group, the age of the deceased was the youngest, the course of psychosis was the shortest and falling from the height was the most common way to commit suicide. Conclusion Understanding the common causes of death of psychiatric patients may contribute to developing measures to reduce the mortality rate of the population. It is necessary to investigate the age, course of psychosis and gender of the deceased when assessing the manner of death.

Set-Up Madness: A Review

@#Psychosis can be defined as a mental disorder in which a person’s thoughts, affective response, ability to recognize reality, and ability to communicate and relate to others are sufficiently impaired to grossly interfere with his or her capacity to deal with reality. The classical characteristics of psychosis are impaired reality testing, hallucinations, delusions, and illusions. While factitious disorder and malingering are usually acknowledged as contrived psychiatric conditions for acquisition of interior or exterior profits, respectively, another alternative, also, exists that though is not manufactured individually, is enforced peripherally. Such cases, which are usually referred by the judge’s ruling, for evaluation and treatment, are more important than comparable simulated or genuine mental conditions, because incorrect diagnosis, or careless, cagily, and guarded validation of preliminary diagnosis that has been issued in the authorized or emergency department, can seriously endanger the individual’s civil rights, while it should not be overlooked that incorrect diagnosis is a kind of malpractice that may harm an individual awfully. In the present article the clinical picture of the said situation, in addition to some case histories, and recommendable hints for differential diagnosis between different types of psychoses, has been discussed.

Analysis of Post-Concussion Syndrome Disability Re-appraisal / 法医学杂志

OBJECTIVES@#To understand the current status of appraisal of post-concussion syndrome disability and the reasons for the changes in re-appraisal opinions.@*METHODS@#The cases that were judged as "post-concussion syndrome and ten-level disability" in the first appraisal and re-appraised for psychiatric impairment by the Academy of Forensic Science in 2019 were analyzed retrospectively.@*RESULTS@#There were 75 cases, including 58 cases with pre-hospital emergency medical records, among which 39 cases were clearly recorded to be without a history of coma; 74 cases had emergency medical records, among which 44 cases were recorded of having a history of coma; 43 cases had follow-up medical records, among which 24 cases had a history of psychiatric follow-up. The most complained symptoms of the appraisee in appraisal and examination include headache, dizziness, poor sleep at night, irritability, memory loss, fatigue and inattention. The main reasons for the re-appraisal application include doubts about the history of coma, doubts about the credibility of mental symptoms, post-concussion syndrome didn't meet the disability criteria, and objections to the original appraisal procedure or the original appraisal agency. The appraisal opinions of a total of 47 cases were changed. Seven of them did not meet the disability criteria, and the main reason was that there was no clear history of coma and no head injury was admitted; the coma history of the 40 other cases had to be confirmed by the court before they can be clearly identified as disabilities. The reason was that the records about the history of coma were inconsistent or there were alterations and additional information.@*CONCLUSIONS@#In the past, the conditions for appraisal of post-concussion syndrome disability were too lax and must be further standardized and strictly controlled.

Reinserción social en la unidad de Psiquiatría Forense en Sancti Spíritus / Social reintegration in the Forensic Psychiatry unit in Sancti Spíritus

RESUMEN Fundamento: la Psiquiatría Forense es la aplicación de los conocimientos psiquiátricos al proceso de administración de justicia. Objetivo: describir el comportamiento de la reinserción social en la Unidad de Psiquiatría Forense de Sancti Spíritus. Métodos: se comunican los resultados del estudio del comportamiento de los asegurados en la Unidad de Psiquiatría Forense de Sancti Spíritus 2016 al 2018. Resultados: predomina el grupo etáreo entre 24 a 35 años, sexo masculino, la esquizofrenia paranoide con los neurolépticos atípicos como modalidad de tratamiento psico farmacológico más utilizado. Se lograron cambios positivos, que ayudó a la solicitud de cese de medida con su posterior reinserción social. Conclusiones: con la aplicación integral de terapias, se logran cambios que permiten la reinserción social, disminuye el riesgo de que puedan delinquir o violentarse en un futuro.

ABSTRACT Background: Forensic Psychiatry is the application of psychiatric knowledge to the justice administration process. Objective: to describe the behavior of social reintegration in the Forensic Psychiatry Unit of Sancti Spiritus. Methods: the results of the study of the behavior of the insured in the Forensic Psychiatry Unit of Sancti Spiritus 2016 to 2018 are communicated. Results: it predominates the age group between 24 to 35 years, male sex, paranoid schizophrenia with atypical neuroleptics as modality of most commonly used psycho-pharmacological treatment. Positive changes were achieved, which helped the request to cease the measure with its subsequent social reintegration. Conclusions: with the integral application of therapies, changes are achieved that allow social reintegration, reducing the risk that they may commit crimes or be violent in the future.

The relevance of Mini Mental State Examination (MMSE) use on demential interdiction exams in judicial proceedings / A importância do Miniexame do Estado Mental (MEEM) nos exames de interdição demencial em processos judiciais

ABSTRACT Objective To highlight the important role of Mini Mental State Examination (MMSE) use on judicial interdiction assessments. Methods On this paper, we present a case in which we have used the Mini mental state examination (MMSE) for screening an initial dementia diagnosis, suggested by clinical and mental state examination. Results The relevance of using a screening test for demencial states on judicial interdictions assessments, as MMSE, in order to provide more objective findings to the court, has been demonstrated. Also, we review the current evidence for using MMSE on this setting and the importance of its use on demential interdiction exams in judicial proceedings. Conclusions Judicial evidence is a critical element in decision making. Judicial interdiction assessment is usually performed by expert psychiatrists. As psychiatric diagnosis relies on clinical history and mental state examination, it is composed of subjective elements, varying also according to the examiner's personal technical orientation and impressions. Neuroimaging exams are helpful on a minority of cases, in which specific findings are present. In such cases, clinical screening questionnaires play an important role - providing objective elements of neuropsychic functioning of an individual, thus limiting the subjective realm of the expert forensic report.

RESUMO Objetivo Destacar a importância do uso do Miniexame do Estado Mental (MEEM) nas perícias de interdição judicial por demência. Métodos Neste artigo, apresentamos um caso no qual aplicamos o MEEM para rastreamento de demência inicial, cujo diagnóstico foi sugerido por meio de história clínica e exame do estado mental. Resultados Foi demonstrada a importância de usar um teste de rastreamento para demência, no caso o MEEM, nas perícias de interdição por esse diagnóstico, a fim de fornecer elementos mais objetivos ao juízo. Ainda, fornecemos uma revisão das evidências atuais para a aplicação do MEEM nesse contexto, bem como a importância do uso dele nas perícias de interdição por demência. Conclusões A prova pericial é um elemento crítico para a tomada de decisão judicial. A perícia de interdição judicial por demência é usualmente realizada por especialistas em psiquiatria. Como o diagnóstico psiquiátrico baseia-se na história clínica e no exame do estado mental, é composto de elementos subjetivos, variando de acordo com a técnica e impressão individual do examinador. Exames de neuroimagem são úteis em uma minoria de casos, nos quais achados específicos estão presentes. Assim, questionários clínicos para rastreamento de doenças mostram-se importantes, pois fornecem elementos objetivos do funcionamento neuropsíquico do indivíduo, diminuindo o papel da subjetividade no laudo pericial.

Working Memory of Patients with Mild Cognitive Impairment due to Brain Trauma Based on fNIRS / 法医学杂志

Objective To discuss the activation characteristics of the prefrontal cortex of people with mild cognitive impairment （MCI） due to brain trauma during working memory tasks. Methods The psychological experiment design software E-prime was used and N-back paradigm was adopted as working memory task. Functional near-infrared spectroscopy （fNIRS） was used to detect changes in cortical oxygenated hemoglobin concentrations of 22 channels within the prefrontal lobe of 24 people with MCI due to brain trauma （study group） and 27 healthy volunteers （control group） with matching gender and age. Behavioral data, such as the number of keystroke errors and reaction time, were recorded simultaneously. Independent samples t test and non-parametric test were used to compare the mean value of oxygenated hemoglobin concentration change, the number of key errors and the mean value of reaction time of the two groups in each task. Results （1） The differences in the number of errors and reaction time between the two groups in 1-back and 2-back tasks had statistical significance （P<0.05）.The main effects of task load and group were both significant （task F=14.11, P=0.001 1; group F=10.39, P=0.001 5）. （2） During the 1-back task, the differences in oxygenated hemoglobin concentration changes of the 22 channels between the two groups had no statistical significance （P>0.05）. During the 2-back task, the differences in oxygenated hemoglobin concentration changes of the two groups in channel 2, 3, 7, 9, 10, 11, 14, 15, 18, 19, 21 and 22 had statistical significance （P<0.05）. （3） In the 1-back task, the left frontal pole and dorsolateral prefrontal area in both groups were activated. In the 2-back task, the activation areas of the control group were the left frontal pole area and the left dorsolateral prefrontal area, while that of the study group almost covered most of the left and right frontal pole areas, which were scattered and the right area was activated, too. Conclusion Patients with MCI due to brain trauma have obvious working memory impairment, and during the 2-back working memory task, the activation of the prefrontal lobe decreased, but the activation range was wider.

Analysis of Scores of SCL-90 of Patients with Traumatic Subdural Effusion / 法医学杂志

Objective To investigate the factors affecting changes of Symptom Check List-90 （SCL-90） of patients with traumatic subdural effusion. Methods One hundred and forty-two cases of patients with traumatic subdural effusion from the Center of Forensic Identification, Wannan Medical College collected from 2007-2018 were tested with SCL-90. The differences between SCL-90 results and the national norm and the influences of gender, age, education level, the number of effusion sites and location on SCL-90 results were analyzed. Results The differences between the scores of somatization, interpersonal sensitivity, depression, anxiety, hostility, terror, paranoia and psychosis factors and total mean scores in SCL-90 of traumatic subdural effusion and that of the national norm had statistical significance （P<0.05）. The differences in depression and hostility factor scores between males and females had statistical significance （P<0.05）. The differences in compulsion, anxiety and terror factor scores and total mean scores among different age groups had statistical significance （P<0.05）. The differences in hostility, paranoia and psychosis factors among patients with different degrees of education had statistical significance （P<0.05）. The differences in depression, anxiety, hostility and terror factor scores and total mean scores among single-site group, double-site group and multi-site group had statistical significance （P<0.05）. The differences in somatization, depression and anxiety factor scores and total mean scores between the right cerebral hemisphere group and the left cerebral hemisphere group and bilateral hemisphere group had statistical significance （P<0.05）. Conclusion Traumatic subdural effusion can cause certain psychological changes, which are related to the primary trauma of arachnoid tear as well as the number and location of effusion sites. Attention should be paid to the influence of the above factors during the assessment of psychological symptoms.

Application of Eye Tracker in Lie Detection / 法医学杂志

Objective To investigate the application value of eye tracking in lie detection. Methods The 40 subjects were randomly divided into two groups. The pupil diameter, fixation duration, points of fixation and blink frequency of the subjects in the experimental group in observing target stimulation and non-target stimulation were recorded with eye tracker after they accomplished the mock crime. The eye movement parameters of subjects in the control group were directly collected. The differences in eye movement parameters of the experimental group and the control group in observing target stimulation and non-target stimulation were analyzed by t-test. Pearson coefficient analysis of correlation between eye movement parameters that had differences was conducted. The effectiveness of eye movement parameters to distinguish between the experimental group and the control group was calculated by the receiver operator characteristic （ROC） curve. Results Participants from the experimental group had shorter average pupil diameter, longer average fixation duration and fewer fixation points （P<0.05）, but the differences in blink frequency had no statistical significance. The differences in the above indicators of the control group in observing target stimulation and non-target stimulation had no statistical significance. The average fixation duration showed a negative correlation with fixation points （r=-0.255, P<0.05）; the average fixation duration showed a negative correlation with average pupil diameter （r=-0.218, P<0.05）; the fixation points showed a positive correlation with average pupil diameter （r=0.09, P<0.05）. The area under the curve of average pupil diameter, average fixation duration and fixation points was 0.603, 0.621 and 0.580, respectively. Conclusion The average pupil diameter, average fixation duration and fixation points obtained by the eye tracker under laboratory conditions can be used to detect lies.

Accuracy Analysis of Distinguishing the Cooperation Degree during Image Completion Test by Eye Movement Parameters / 法医学杂志

Objective To analyze the differences in accuracy of different eye movement parameters in distinguishing the cooperation and non-cooperation during image completion test of patients with mental disorders caused by craniocerebral trauma. Methods One hundred and forty cases of patients with mental disorders caused by craniocerebral trauma who took psychiatric impairment assessments were collected. The 21 pictures from "image completion" of Wechsler intelligence test were used as stimulating pictures, then divided into cooperation group and non-cooperation group according to binomial forced-choice digit memory test and expert opinions. The eye movement parameters of research subjects during completion of images were obtained by the SMI eye-tracker. The accuracy of eye movement parameters in distinguishing the cooperation or non-cooperation of patients with mental disorders caused by craniocerebral trauma in psychiatric impairment assessments were evaluated by the ROC curve. Results During the process of the image completion test, the area under curve （AUC） value of frequency of blink, frequency of fixation, pupil size, frequency of saccade, latency of saccade, average acceleration of saccade, the average and peak longitudinal velocity of saccade was above 0.5. When it comed to a specific stimulating picture, the AUC value of frequency of blink in looking at a specific stimulating picture could be above 0.8, and the AUC value of X axis diameter of pupil size could be above 0.7. Conclusion The accuracy of eye movement parameters in distinguishing the cooperation or disguise of patients with mental disorders caused by craniocerebral trauma is related with the stimulating picture. The accuracy of frequency of blink in distinguishing cooperation and non-cooperation is better than that of other eye movement parameters.