Forensic criteria, clinical and theoretical issues of the indication of court-ordered treatment: A comparative survey among experts in forensic psychiatry and sentencing judges in France.

Following the French law n° 98-468 of 17 June 1998 relative to the prevention of sexual offenses and the protection of minors, social and judicial follow-up and court-ordered treatment were introduced with the aim of reinforcing the prevention of recidivism. Court-ordered treatment is one of the possible obligatory measures provided for by social and judicial follow-up. However, there is no consensus between the different professionals concerning the criteria of indication and the final purpose of this measure. Most of the few available studies are retrospective. Only rare studies have assessed the influence of criminological factors on the indication of court-ordered treatment. We carried out a nation-wide qualitative comparative study in two populations, psychiatric experts and sentencing judges, by means of e-mail questionnaires. The aim was to determine the criteria for court-ordered treatment according to psychiatric experts and to sentencing judges, to identify the criteria that gave rise to differences in appreciation between these professionals, and to attempt to explain these differences. The secondary aim of the study was to determine the methods and tools used in expert practice to evaluate dangerousness and risk of recidivism. We obtained 20 responses in each of the two populations. The great majority of psychiatric experts and sentencing judges considered that court-ordered treatment was appropriate when the offender presented with psychiatric dangerousness, and so with an underlying mental disorder. When a subject had no identified mental disorder, the psychiatrists were divided in their opinion, whereas the majority of sentencing judges were in favor of court-ordered treatment. Opinions differed particularly significantly between the two populations in four circumstances: a subject with an antisocial/psychopathic personality disorder, a subject who denied the alleged acts, the influence of precarious social circumstances and the influence of instability in intimate relationships. The majority of experts used international classifications (DSM-5 and ICD-10) as a basis for their psychiatric diagnosis. Just under half of those surveyed used structured or semi-structured interview guides and only a few stated that they used standardized actuarial tools to assess risk of recidivism. The concepts of care, dangerousness and mental disorder are associated with multiple representations that certainly play a part in the disagreements between the different professionals. It is of prime importance to define these concepts more clearly in order to encourage the use of a common language and to clarify the indications and purpose of court-ordered treatment. We also hypothesize that disagreements between professionals regarding the criteria for court-ordered treatment may be related to certain difficulties raised by the management of the convicted person. The development of guidelines that could be used by all professionals would help to reduce some of these difficulties. Psychiatric experts remain attached to clinical evaluation. Their limited use of assessment tools may relate to the material constraints and time constraints involved. The issue at stake in court-ordered treatment and social and judicial follow-up is to promote cooperation between the various professionals by creating a space for exchange of ideas where the fundamental questions raised by these measures can be discussed, fears shared and knowledge pooled.

Parenteral nutrition consensus report from KEPAN.

OBJECTIVES: Medical nutrition therapy is one of the core components of patient management, although its implication is still limited in Daily practice globally. Clinicians are in need of guidance that will ease the application of medical nutrition therapy. The pre- and post-graduate curriculum for medical nutrition therapy is limited in most regions, worldwide. A report that is short, clear, and having clear-cut recommendations that will guide the primary healthcare professionals in indications, choice, practical application, follow-up, and stopping parenteral nutrition (PN) would facilitate the application and success of medical nutrition therapy. KEPAN is the Clinical Enteral and Parenteral Nutrition Society of Turkey and is an active member of the European Society for Clinical Nutrition and Metabolism (ESPEN). METHOD: In this study, we present the KEPAN PN consensus report on optimal PN use in medical nutrition therapy as outlined by the works of academicians experienced in the clinical application of PN (nine working group academicians and 10 expert group academicians). RESULTS: This report provides 22 clear-cut recommendations in a question-answer format. CONCLUSIONS: We believe that this report could have a significant impact on the optimum use of PN in the context of medical nutrition therapy when clinicians manage everyday patients.

The Quality of Violence Risk Formulation and a Quasi-Forensic Mental Health Training Experiment / La calidad de la formulación de riesgo de violencia y un cuasi-experimento de entrenamiento en salud mental forense.

Objectives: The study was aimed at measuring the impact of training on forensic case formulation in mental health and to provide more evidence on the reliability of the TEC-F. Method: Nine psychiatrists and six psychologists from various Latin American countries participated in a quasi-pedagogical experiment. The quality of formulations was independently and blindly measured pre- and post-intervention with the TEC-F and the assignment of two standard vignettes was also randomly manipulated. Quality mean differences and instrument reliability indicators were calculated. Results: The values of intraclass correlation coefficients were 0.92; 0.94; 0.83; 0.93 and 0.95 and the values of Cronbach's alpha coefficient were 0.83; 0.94; 0.63; 0.77 and 0.93, for the dimensions transparency, specificity, communication, reasoning and for the total TEC-F respectively. The results of the 19-day test-retest were excellent. The mean TEC-F total quality pre-course was 31.4 and the mean post-course, 38.4 (p = 0.003 and p = 0.001 for group test and paired test respectively). Conclusions: The pedagogical intervention produced a significant improvement in the quality of the expert's formulations. The study added evidence supporting the TEC-F reliability.

OBJETIVOS: El estudio se propuso medir el impacto de un entrenamiento sobre formulación pericial del caso forense en salud mental y extender evidencias relacionadas con la confiabilidad de la TEC-F. MÉTODO: Nueve psiquiatras y seis psicólogos de diversos países latinoamericanos participaron de un cuasi-experimento pedagógico. Se midió independientemente y a ciegas la calidad de las formulaciones con la TEC-F pre y post intervención y también se manipuló aleatoriamente la asignación de dos viñetas estándares. Se calcularon diferencias de medias e indicadores de confiabilidad del instrumento. RESULTADOS: Los valores de coeficientes de correlación intraclase fueron 0,92; 0,94; 0,83; 0,93 y 0,95 y los valores del coeficiente Alfa de Cronbach fueron 0,83; 0,94; 0,63; 0,77 y 0,93, para las dimensiones transparencia, especificidad, comunicación, fundamentación y para el total TEC-F respectivamente. Los resultados del test-retest a 19 días fueron excelentes. La media de calidad total TEC-F precurso fue 31,4 y la media post curso, 38,4 (p = 0,003 y p = 0,001 para prueba grupal y para prueba apareada respectivamente). CONCLUSIONES: La intervención pedagógica produjo una significativa mejoría en la calidad de las formulaciones periciales. El estudio adicionó evidencias sosteniendo la confiabilidad de la TEC-F.

When legal procedures facilitate abandonment. New forms of Ghosting / Cuando los procedimientos judiciales facilitan el abandono. Nuevas formas de Ghosting.

Ghosting has become a way to end abruptly short/casual relationships. It is the practice of ending a personal relationship suddenly and without explanation withdrawing from all communication. Nowadays at family courts, the quality of psychology expert witness reports is limited to transcribe the interviewed person words, without applying any professional method tending to elaborate a diagnosis.On the other side, usually the formal procedures mandated by the law are not followed, may be due to the excessive amount of work. These two reasons lead to impose home exclusion or different kind of restrictions to see one or more members of the family, measures that facilitate de abrupt termination of the family bond, developing serious psychological consequences to the excluded person. Attempts are made to warn about the need for real expert reports that help judges to improve decision-making, to not facilitate long term family relationships ending.

El ghosting (fantasmeo o desaparición) se estableció como una forma de terminación de relaciones breves y sin compromiso. Consiste simplemente en cortar todo tipo de comunicación y no dar señales de vida de forma abrupta. Por otro lado, los informes psicológicos en los tribunales de familia, habitualmente se limitan a transcribir los dichos de las partes entrevistadas, sin efectuar ningún otro acto profesional que no sea el mero relato. Esto, sumado al no seguimiento de los procedimientos de la ley, terminan facilitando el cese abrupto no de relaciones cortas, sino parejas de larga data, o hasta inclusive matrimonios, mediante exclusiones de hogares o imposición de perímetros de exclusión, con las innumerables consecuencias para la persona ghosteada y la familia. Se intenta advertir, sobre la necesidad de la realización de verdaderos informes periciales, que ayuden a los magistrados a mejorar la toma de decisiones, que no faciliten la finalización abrupta de relaciones familiares de larga data.

Training the Environmental Military Police in the State of São Paulo for science-based assessment of animal mistreatment.

The aim of this study was to analyze the perception of police officers within the Environmental Military Police of the State of São Paulo about animal abuse occurrences and to implement the Protocol for Expert Report in Animal Welfare (PERAW) as guidance for the first approach to complaint cases related to animal mistreatment. 608 officers filled a pre-implementation questionnaire, followed by a training for PERAW use, and filled a post-implementation questionnaire after two months of Protocol use; these last two were accomplished by only 200 officers. Feeding and water inadequacies were quoted as the condition most easily identified as maltreatment. After training, more officers mentioned two and three animal welfare segments of physical, behavioral, and mental aspects. The concept of sentience was known by a significant higher number of officers after training. Officers reported that the main PERAW advantage was that it enabled greater discrimination and more appropriate assessment of occurrences, besides providing a technical basis to the assessments. Overall, PERAW implementation provided some guidance for a first approach to animal mistreatment cases; however, continued training may provide further improvement.

PRESUMPTION OF MENTAL HEALTH VS FORENSIC PSYCHIATRIC EXAMINATION REPORT: MEDICAL AND LEGAL ASPECT.

OBJECTIVE: The aim: The aim of this work is a legal analysis of the mental health presumption and its application by judges in assessing the report of the FPE; formulation of scientifically substantiated proposals for determining the criteria for the judge's assessment of the FPE report in refuting the presumption of mental health context. PATIENTS AND METHODS: Materials and methods: The basis for the article was the results of scientific research published by representatives of different states regarding the criteria for assessing the expert's opinion as a procedural source of evidence; legislation (in the field of psychiatric care and criminal justice) of a number of European and Asian states and its implementation xperience; results of the survey of 88 judges conducted by the authors (judges of local courts of Ukraine, the survey was conducted in 2020) on key issues of ensuring the participation of a person suffering from a mental disorder in a court hearing. In this research, a complex of general and special scientific methods of cognition was used (comparative legal method, systemic-structural method, generalization method, method of analysis and synthesis, method of sociological research, method of expert assessments, etc.). RESULTS: Results: According to the results of the research: a) it is stated that the presumption of a person's mental health is a common European standard, regardless of the normative consolidation at the level of domestic legislation; b) it is proved that the effectiveness of the judge's use of the presumption of mental health in criminal proceedings directly correlates with his or her competent assessment of the FPE report and the providing appropriate argumentation in a court hearing; c) the factors that allow the judge to correctly assess the report of the FPE and put it in the basis of decision-making (that is, to refute the presumption of mental health of a person), or, on the contrary, to deny it (stating that the presumption of mental health has not been abolished). CONCLUSION: Conclusions: As a principle of modern psychiatry, the presumption of mental health is directly correlated with the FPE report, based on which it can be refuted. This determines the special importance of a competent assessment of this procedural source of evidence, the need for the judge to take into account several factors and to provide appropriate argumentation in the court hearing.

[Bernhard von Gudden's psychiatric assessment and the deposition of King Ludwig II of Bavaria in 1886 : Comments on the article by R. Steinberg in Der Nervenarzt 01/2019]. / Das psychiatrische Gutachten Bernhard von Guddens und die Entmachtung König Ludwigs II. von Bayern 1886 : Ein Kommentar zum Beitrag von R. Steinberg in Der Nervenarzt 01/2019.

King Ludwig II of Bavaria drowned himself in Lake Starnberg on 13 June 1886 after subduing and drowning Bernhard von Gudden, a Munich-based psychiatrist who had tried to hold him back. Commissioned by Prince Luitpold, Ludwig's successor to the throne, von Gudden had provided a psychiatric assessment on the king. Finding him to be suffering from a progressive mental illness and paranoia (madness), he declared Ludwig incapable of ruling. On the basis of this report Ludwig was unlawfully declared incapacitated, deposed, arrested and locked up in the Berg Castle under von Gudden's medical supervision. We conducted a 5-year psychiatric historical study of King Ludwig II, the most thorough of its kind ever undertaken. The main results were: the private, official and political letters the king wrote until his very last day were reasonable, well-argued and impeccable in style. Until his final days Ludwig had invariably fulfilled his administrative tasks in a prompt and proper way. His handling of political affairs was also wise and reasonable. Due to social phobia afflicting him since his youth he neglected his representative duties as a monarch. Von Gudden's report is marred by severe flaws. In his article published in Der Nervenarzt (01/2019) R. Steinberg adopts von Gudden's psychiatric diagnosis and misjudgement. Steinberg writes that the king's illness developed "in a clear crescendo". In fact, it was the behavioral anomalies associated with the king's homosexual relationships that grew increasingly prevalent at the court, whereas Ludwig's mental efficiency improved over time. Given the historical misjudgment and numerous other errors that Steinberg adopts from von Gudden, I considered it necessary to compare and contrast his conclusions with results from our own research.

Life Expectancy Expert Reports: Common Mistakes and Appropriate Process.

Life expectancy expertise must comply with court-mandated evidentiary standards. A proper opinion should abide by 3 principles; it should be generated by a qualified expert who applies proper methods to appropriate facts. Several common mistakes can make opinions unsuitable for admission into testimony by straying from 1 or more of these 3 principles. Examining life expectancy opinions in light of these principles allows consumers of life expectancy expertise to evaluate the quality of the opinions proffered.

Nutrition and cancer: prevention and survival.

Cancer is increasing worldwide. Patterns of cancer are also changing. The evidence is summarised in the 2018 World Cancer Research Fund/American Institute for Cancer Research report Diet, Nutrition, Physical Activity and Cancer: a Global Perspective. The plasticity of cancer patterns implicates environmental factors as determinants of cancer, and nutrition influences key cellular and molecular processes that characterise cancer. Epidemiology identifies associations between aspects of diet, nutrition, and physical activity with one or more cancers; there is evidence for plausible mechanisms that imply that these are causal. Some nutritional exposures (alcohol and processed meat) are likely causal factors, but no singular factor protects against cancer (except dietary fibre for colorectal cancer). Cancer protection mainly derives from a systemic metabolic environment that promotes healthy cell replication and tissue integrity. Such a nutritional state reflects avoiding excess adiposity through healthy dietary patterns rich in plant foods (legumes, wholegrains, pulses, vegetables and fruits), with modest meat, fish and dairy, low in alcohol and salt preserved foods, and an active way of life, avoiding sedentary behaviours. Less is known about the impact of nutritional interventions in people with a diagnosis of cancer, but nutrition including adiposity and physical activity predict breast cancer outcome. Promoting healthy ways of life requires public information and education, but alone these do not generate change; a socio-political and cultural environment that is conducive to adopting healthy behaviours is needed. Uncertainties in the evidence offer promising directions for future research, but sufficient is known to act as a basis for public policy and clinical practice.

Formulation and communication of evaluative forensic science expert opinion-A GHEP-ISFG contribution to the establishment of standards.

Communicating and interpreting genetic evidence in the administration of justice is currently a matter of great concern, due to the theoretical and technical complexity of the evaluative reporting and large difference in expertise between forensic experts and law professionals. A large number of initiatives have been taken trying to bridge this gap, contributing to the education of both parties. Results however have not been very encouraging, as most of these initiatives try to cope globally with the problem, addressing simultaneously theoretical and technical approaches which are in a quite heterogeneous state of development and validation. In consequence, the extension and complexity of the resulting documents disheartens their study by professionals (both jurists and geneticists) and makes a consensus very hard to reach even among the genetic experts' community. Here we propose a 'back-to-basics', example-driven approach, in which a model report for the two most common situations faced by forensic laboratories is presented. We do hope that this strategy will provide a solid basis for a stepwise generalisation.

Trastornos mentales de origen laboral: calificación y ponderación de riesgos / Work related mental disorders: diagnosis and risks assesment

En el artículo se presentan y discuten los resultados de la evaluación realizada a 44 trabajadores referidos por el Instituto de Seguridad Laboral, como presuntos portadores de un trastorno mental de origen laboral. Metodología: se trata de un estudio exploratorio, para el cual se combinaron entrevistas psicolaborales semi estructuradas, entrevistas psiquiátricas estandarizadas, y entrevista psiquiátrica tradicional. Resultados: 85 por ciento de los casos presenta un trastorno mental actual, mayoritariamente depresivo, atribuible al trabajo. Como origen del malestar, la gran mayoría de los entrevistados refiere problemas interpersonales al interior del trabajo, en especial, conflictos con la jefatura. Discusión: la proporción de casos calificados como laborales en este estudio contrasta fuertemente con lo que ocurre en las mutualidades de empleadores. Ello, más la dificultad para identificar un perfil claro que diferencie a quienes presentan un trastorno mental laboral de uno común, lleva a preguntarse sobre la pertinencia de la ley y del marco institucional chileno para proteger la salud mental de los trabajadores.

The article presents and discusses the results of the evaluation of 44 workers sent by the Instituto de Seguridad Laboral as they presumably may suffer from a work-related mental disorder. Methodology: this is an exploratory research based on a combination of psychological semi-structured interviews (focus on the interviewee’s work condition), standardized psychiatric interviews and traditional psychiatric interviews. Results: 85 percent of cases present work-related mental disorder, most of them depressive, accountable to work conditions. As the origin of their discomfort, the vast majority of the interviewees refer interpersonal problems at work, especially, conflicts with their leaderships. Discussion: the proportion of cases diagnosed as work-related in this study strongly differs of what happens at the Mutuales de Empleadores, which in addition to the difficulties to identify a clear profile that distinguish those who present a work-related mental disorder from those who do not, leads us to question the pertinence of the current Chilean law and institutional framework to protect workers’ mental health.