The role of personality assessment in forensic driving license renewal procedures. A study supported by the MMPI-2 test.

Abstract: The main function of the medical-psychological assessment to evaluate fitness to drive (FTD) is to safeguard the community against risks posed by drivers who, owing to psycho-physical disease, personality disturbances, abuse of psychotropic substances or drugs, can be a hazard to safety on the roads. In the context of psychodiagnostic investigations, the Minnesota Multiphasic Personality Inventory 2 (MMPI-2) test is the gold standard tool supporting clinical assessments conducted to evaluate a subject's capacity to predict her/his own actions, attitudes, risk propensity, level of conformity to social norms. Other important features of the tool include the specific scales aimed at individuating behaviors adopted with the intent to elude or hide existing personality problems. These behaviors are very frequent in the field of medicolegal, psychological and psychiatric assessments, including FTD evaluations. In this study, the MMPI 2 test was administered to 154 subjects for whom Driving Licence (DL) Medical Commissions based in the south of Italy had required specific personality assessments, compared to a control group of 186 subjects with no clinical or psychodiagnostic problems. The question posed in our study was to understand whether the test was able to detect differences between the personalities of the subjects belonging to the two groups. The results obtained demonstrated significant differences between the experimental group and the controls, shown by the MMPI-2 variables, in particular the clinical Hs scale,the supplementary scales: GF, Re, AAS, APS and the content scales DEP and TRT, as well as the PSY-5 Disc and Nege scales.

A firearm double homicide committed by a paranoid neigh- bor: a psychopathological study.

Abstract: Serious mental illness is associated with a higher risk of violent interpersonal behavior. Characteristic traits denoting a psychopatho-logical picture such as schizophrenia, depression, a borderline, or narcissistic, antisocial, or paranoid personality disorder, are frequently observed in the personality of those who have committed one or more murders. For example, mass murderers are affected by a delusional syndrome with a persecution fixation, that develops in a subject with a paranoid, anacastic personality disorder. An abnormal mental frame-work develops as a consequence of continual experiences interpreted as traumatic. We present a complex case regarding a double murder whose vic-tims were shot by a 50-year-old neighbor, who underwent a psychiatric evaluation for the assessment of criminal responsibility. In the light of the historical reconstruction of his relation sensitive delusional mindset that triggered the final reaction, his life history, the "key event" and the "triggering environment" (constant conflictual and dysfunctional rela-tions with others) led to the violence. The correct understanding of the reported case demands investigation not only of the clinical, diagnostic and psychodiagnostic aspects, but also of the perpetrator-victim/s, their relational context and the situation where the crime evolves, in order to be able to reconstruct the event in a meaningful manner.

From doctor to incendiary nun: the importance of analysing the pathways of trauma.

ABSTRACT: Childhood traumatic experiences have often been associated with the development of severe psychiatric disorders or, at least, with serious impairment in the victims' developing personality. Emotional abuse and neglect can cause gradual damage to Self-image and to models of self-in-relation to Others. We report a case of a woman who underwent psychiatric evaluations for marriage annulment. The issues were the as-sessment of the outcomes of early psychic trauma and the examination of the remaining individual capacities from a judicial standpoint. The examiners found that the memories of the woman's history of childhood abuse had become integrated into her personality organization. The spheres most strongly influenced were those of psycho-sexual/affective maturation and a dysfunctional bond with religion. Psychodiagnostic evaluation diagnosed a Borderline Personality Disorder. The complexity of the case suggests the need of a multi-dimen-sional analysis by an interdisciplinary team including experts in legal medicine, forensic psychiatry and psychology as well as clinical crimi-nology.

A para-religious setting for financial exploitation of the mentally incapacitated: when the habit doesn't make a monk.

ABSTRACT: Exploitation and circumvention of the mentally incapacitated is a criminal offence listed in the Italian penal code (Penal Code Art. 643). It involves the exploitation and circumvention of people who are fragile and vulnerable owing to their health conditions and/or mental status, and fits into the grey area between such subjects' freedom to make decisions about their physical conditions and economic assets, and the abuse of their trust perpetrated by third parties for personal gain. The authors describe a case of financial exploitation and circumven-tion of a married couple that is remarkable in view of both the huge sums extorted from the victims and the duration of the peculiar illicit activities (that lasted more than 10 years). These were perpetrated by a charismatic figure leading a "para-religious" group. He claimed to be a prophet, but his private life was highly questionable. The method of ascertainment used to verify the victims' mentally incapacitated state is described, analyzed and commented; the diagnosis could not be deferred in view of the characteristics of the prolonged penal offences committed.

The aging process in prison: pathologies and health conditions in old inmates. An epidemiological research in Italy.

BACKGROUND AND AIMS: Elderly may suffer from different pathologies during their detention in jail because of their age. Conditions in jails were tough and adapting to that life could be problematic for the elder population. This article aimed to analyse the pathologies and health conditions in a sample of elder inmates from Italy. METHODS: The sample was composed by 94 elderly inmates. The research is multicentric. We selected jails from the cities of Bari, Taranto, Foggia, Lecce, Brescia, Bergamo, Cremona and Mantua. The study was conducted by interviewing the prisoners over 60 years of age, in the period between September and December 2017. RESULTS: 64% of the sample was in a "Not Optimal" health status. Most of pathologies were Cardiac pathologies (23.4%), Diabetes (12.8 %) and Surgery (9.6%). Statistically significant differences were found for heart disease (p=0.02) and Neoplasia (p=0.025) in the prison of Bari compared to all the other prisons. Statistically significant differences were found for Hypertension in Foggia and Taranto prisons compared to all the other (p=0.023). Furthermore, 18.1% of inmates ended up having an addiction. CONCLUSIONS: Our analysis showed that in our sample physical problems were more frequent than psychological one. In fact, in spite of in the literature there was a high prevalence of mental health problems among elderly inmates, we did not find this result. However, stress conditions may increase the risk of pathologies: for example, being in jail and adapt to new hard environment may increase the risk of getting sick. Heart disease pathologies and diabetes were very common in our sample as confirmed by the literature.

Some reflections on the issue of homicide-suicide prompted by a case series of forensic psychology assessments.

From the criminologic standpoint, as a crime committed against a psychological background of depression, homicide-suicide is a "dual death" whose significance transcends the specificity of the two events taken singly. Although diametrically opposite phenomena, in fact they share the same pulsions, to be found in aggressiveness, or the desire to eliminate the tensions underlying it. From this perspective, various attempts have been made to classify the homicide-suicide phenomenon, which have indicated that those who, through homicide, deprive themselves of their primary source of gratification may then decide to commit suicide as a result of this unbearable loss. Therefore, suicide post-homicide is a marker of the importance of the bond between the murderer and the victim. Indeed, some Authors have confirmed that the strong attachment between the two increases the likelihood of suicide of the former after the death of the latter; that the crime develops in a relational context featuring abuse and maltreatments; that it also stems from the fear of betrayal and the loss of an object that escapes all attempts to possess it, and that in many cases the destruction of the object through the crime is followed by the self-destruction of the criminal.

The contribution of the TIPE (Test di Induzione PsicoErotica: PsychoErotic Induction Test) to the assessment of erotic fantasies in subjects affected by gender dysphoria: a case series.

Research into sexual aspects poses a fascinating challenge that is highly cogent to clinical profiling disciplines, but also constitutes a more 'narrative and culturally oriented' approach to medicine and psychology. Assessments of subjects affected by gender dysphoria and their internal, relational and sexual world is a still more complex task, since these are very distressing and tormented issues for the subjects under study. Psychodiagnostics can be an important element in the various investigative, evaluative and therapeutic pathways. The authors have focused attention on the TIPE (Test di Induzione PsicoErotica: PsychoErotic Induction Test), an Italian projective psychodiagnostic tool that is used to explore the psychoerotic fantasies of subjects affected by gender dysphoria. The TIPE tests protocols of two samples of subjects have been examined. They projected particularly rich narrative aspects of the subjects' psychoerotic imaginary world. The first sample, a clinical series, consisted of a total of eleven subjects, nine men and two women, mean age 43 years, who were undergoing assessment, firstly psychotherapeutic and then medicolegal, for sex rectification purposes; the second sample, the controls, consisted of fourteen subjects, nine men and five women, mean age 28 years, all heterosexual and with a problem-free history of sexual identity.

The Kanun as a self-governance code in Italian-Albanian criminal contexts: A research conducted in the Republic of Albania.

The Kanun is an important manifestation of Albanian consuetudinary law in force at a given historical moment. It is characterized by the absence of institutions or bodies set up to design and impose rules, norms or precepts that could maintain order and ensure that within the community, the associates can live and carry out their activities in observance of and compliance with the rules and precepts imposed by the State authorities. Active operation according to the Kanun rules is not only common among the populations settled in the mountains of Albania but also, and above all, in the context of Albanian criminality which, as is well known, has also spread to Italy, creating partnerships and cross-contaminations with Italian crime. The research was carried out mainly in Albania at the bodies and institutions responsible for dealing with and controlling crime in the nation, but also focuses on the issue of connections with, and influences on, Italian crime.

Lying in the medicolegal field: Malingering and psychodiagnostic assessment.

The simulation of mental illness, so-called "Malingering", is a very difficult phenomenon for professionals to identify when making an assessment, especially in the medicolegal and forensic psychology and psychiatry fields. When malingering, the subject implements strategies that mimic the symptoms related to a possible psychiatric disease, with the aim of misleading the operator. It is necessary, therefore, to elicit a complete medical history and make a close clinical examination and, especially, to be able to rely on appropriate diagnostic tools. Another important aspect, in the legal medicine, and forensic psychology and psychiatry fields, is the opposite strategy, namely that of dissimulating, or masking, a disease. Several diagnostic tools that the professional clinician can employ to identify dissembling strategies are considered in this article, namely the MMPI- 2, PAI, M- Fast, the SIRS and, finally, the SIMS.

The wish 'not to be'. Survey of suicide cases arriving at the Prosecutor's Office of the Court in Bari in the years 2014-2016.

The issue of suicide has always been a very sensitive and important problem, that raises many questions in the society where it occurs, that is not always able to oppose an adequate response. Every scientist in the field agrees that this is an act provoked by multifaceted reasons, which include cultural, social and biographical motives. Therefore, this topic also poses ethical and civil problems, as well as epistemologic and research methodology issues, because of its complexity as a subject of study. The authors propose a case-by-case contribution, evaluating the judicial acts on 73 suicides made available by the Bari Public Prosecutor's Office for the years 2014-2016. The authors believe collected and systematized data, and the ensuing considerations, can offer a contribution to the debate in the field of legal and socio-healthcare actors, who are often the first to deal with and confront this complex and tragic phenomenon.

Awareness of the offense and perception of the victim among juvenile sex offenders.

INTRODUCTION: The present work presents data on research into adolescents who committed sex offenses, carried out in the Apulia Region of southern Italy and focused in particular on the perpetrators' perception of the peculiar profile of the criminal act committed. MATERIALS AND METHODS: Three University sections of the School of Medicine, Bari University, took part in this research: Criminology and Forensic Psychopathology, Psychiatry and Juvenile Neuropsichiatry, working in collaboration with the Department for Juvenile Justice and the Community, and the Center for Juvenile Justice in Apulia. In total, 31 subjects were included in the study, all Juvenile Sex Offenders. A detailed questionnaire was employed to obtain all the relevant information of criminological concern. DISCUSSION: Among most of the minors considered, a very poor awareness emerged of the peculiar type of offense committed, and of its consequences on the victims and the social context. RESULTS: This finding highlights an evident contradiction and confusion between legislative provisions in the area of sex offenses and rape, and the perspectives of juveniles and adolescents. CONSLUSIONS: There is an evident need for legislative norms to adopt registers that are more accessible to the complex juvenile world, that cannot be assimilated to the adult world.

A singular case of asphyxia by choking on a handkerchief: accidental event or suicide to "shut-up" spirits.

Choking in adults can prove fatal, despite resuscitation attempts. The manner of death can be natural, homicide or accident. When a death is due to choking, one must consider what conditions contributed to or predisposed the person to choking (eg. alcohol, drugs and physical and mental impairments). Homicidal deaths by choking are relatively uncommon, being more frequently accidental. The diagnosis of death by choking is made at autopsy when the airway is found occluded. If the individual had an occluded airway and the object or food was removed during resuscitation, the only way to make the diagnosis would be on the history. Here, we present a case of asphyxia (accidental or suicidal) by choking on a handkerchief in a patient with a long history of schizophrenia. The woman had attempted a previous suicide driven by evil spirits coming from inside her body, especially from the head and throat; in order to "shut-up" the spirit, she was trying to suffocate it with her hands or by a belt from her pants.

Multiple stab wounds: understanding the manner of death through the psychological autopsy.

A 48-year-old physical therapist with no history of psychiatric disorders or suicidal tendencies was found dead by his relatives inside his apartment. Multiple stab wounds were present on the chest and the abdomen. Several more superficial cuts were also seen on the neck and the left wrist. At the death scene, there was a large pool of blood in the room, with secondary droplets and stains; a kitchen knife was found beside the body, and a suicide note on a table. Especially the number of wounds raised strong suspicion of a homicide in the first instance but some circumstances (the farewell letter, the absence of clothing injuries, no signs of third-party involvement) and autopsy findings (absence of defense or blunt injuries, the localization of the wounds, the presence of hesitation marks) pointed toward a suicide etiology. Because of the many stab injuries and the lack of a psychiatric history, further forensic investigations were required including a so-called psychological autopsy. This case report highlights that only a comprehensive interpretation of all the elements (circumstances, the scene of death, autopsy findings, and psychological autopsy) can lead to the correct solution of atypical cases of suicide.

The Tragic Tale of a Father and Son: an Unusual Patricide.

Parricide is a category of homicide in which the victims are the parents, and the killers, their children. The authors report a case of a 45-year-old man who killed his 73-year-old widowed father in an extremely violent manner: he struck the father in the head with a wooden wash board, stabbed him with a pair of scissors and several times with a screwdriver. Afterwards, he kicked the victim in the face and jumped up and down on his body, thereby crushing the father's chest with his weight. The case reported here may be classified as an "unusual patricide" when one considers the age of the aggressor, the diagnosis of psychiatric disorders, that the victim was the father, and that the murder was committed in an extremely violent manner.

[A couple in the sect: between freedom of membership and risks of abuse]. / Una coppia nella setta: tra libertà di adesione e rischi di abusi.

Psychological cults are of particular interest to criminologists due to their complex and multi-faceted structures. They may come in the form of organizations, movements, and training centers that make promises to their victims of developing or strengthening their psycho-relational capacities, thus resulting in improvements in their social, professional, and personal lives. Starting from the complex and delicate story of a professional couple who join a cult, the authors describe one case of a organization that are referred to as "psycho-sects", and with a significant number of followers. These cases came to our attention through judicial authorities, and they offer us an opportunity to look at two aspects associated with psycho-sects: The need of individuals to belong to such groups; and the risk of abuse and violence that they face.

[Parricide, abuse and emotional processes: a review starting from some paradigmatic cases]. / Parricidio, abusi e processi emozionali: una rassegna partendo da alcuni casi paradigmatici.

The authors of this study tackle the complex subject of parricide, which is a rare and often brutal form of homicide. Parricide has a high emotional impact on public opinion and on our collective imagination, especially in light of the fact that the perpetrators are often minors.. Three striking cases of parricide, taken from various documented sources and judicial files from the "N. Fornelli" Juvenile Penal Institute (Bari, Italy), are presented here. A review of the literature on the topic has revealed differences between parricides committed by adults and those committed by minors. In the end, the complex issues underlying such an unusual crime are connected to abuses and maltreatment that minor perpetrators of parricide have suffered, especially the emotional processes that are activated.

[Judicial psychiatric hospital closings. Workers' expectations in rehabilitation facilities: A pilot study from the Province of Taranto (Italy)]. / Verso la chiusura degli Ospedali Psichiatrici Giudiziari.Aspettative degli operatori delle strutture riabilitative: unaricerca pilota nella Provincia di Taranto (Italia).

SCOPE: The aim of this study is to gain a clear understanding of the level of knowledge and training of staff members from psychiatric rehabilitation services in the Province of Taranto (Italy), where patients released from judicial psychiatric hospitals will be admitted. MATERIALS AND METHODS: A questionnaire taken from an earlier study on judicial psychiatric hospitals, conducted by The Ministry of Justice of the Department Penitentiary Administration - Superior Institute of Penitentiary Studies, was used in this study. Were contacted in advance of Directors 8 Community Rehabilitation and Psychiatric Care and Day Care Centres 7 present the province of Taranto, who has sought membership survey. RESULTS: Many requests for information and training regarding the problems and challenges related to the management of individuals who are mentally ill, perpetrators of crimes, and persons who are held in protective custody are made by those who work in these institutions. CONCLUSIONS: Hospital workers are highly apprehensive with regard to working with a patient population quite different from that which they are normally accustomed to. In order to confront these challenges, they, together with other colleagues from both the private and public services sector, have turned toward the concept of teamwork. One element of contradiction seems to be a low level of knowledge regarding what will be required of them when their work will be connected to the world of criminal justice in the future. The workers who were interviewed who have experience in working with patients from Judicial Psychiatric Hospitals seem to be up to the task of meeting the complex needs of the mentally ill and perpetrators of crimes within psychiatric rehabilitation facilities, as these patients must be kept under security.

False accusations of sexual abuse as a mean of revenge in couple disputes.

OBJECTIVE: In forensic-psychiatric evaluations on a minor presumed victim of sexual abuse, one may come across "false positives" and "false negatives". The aim of this study was to examine the phenomenon of false sexual abuse as revenge by one ex-partner against the other, and to offer recommendations about how to avoid this risk. MATERIALS AND METHODS: The authors examined 75 technical consultations and expert testimonials in which intrafamilial sexual abuse of a minor was reported. RESULTS: Twenty two (30%) were found to be baseless and result of conflict, revenge of one partner upon the other. Of these 22, 5 involved men who accused their ex-wives and/or live-in partners. The remaining 17 cases involved charges by women against their ex- husbands, and/or live-in partners. CONCLUSIONS: Charges of abuse represent not only an instrument of protection of one's own children, but also a weapon of revenge against an ex-partner, putting these minors into the role of victims.

Novel therapeutics for the treatment of familial Mediterranean fever: from colchicine to biologics.

Familial Mediterranean fever (FMF), an inherited autosomal recessive disorder, is characterized by sporadic, paroxysmal attacks of fever and serosal inflammation, lasting 1-3 days. Patients may develop renal amyloidosis, arthritis, serositis, and skin and oral lesions. Diagnosis is based on clinical features, response to treatment with colchicine, and genetic analysis. Colchicine prevents attacks and renal amyloidosis, in addition to reversing proteinuria. Nonresponders may receive novel therapy, including interleukin (IL)-1 receptor antagonists and IL-1 decoy receptor. Recently, new options have been considered.

Women and alcohol. A survey in the city of Barletta.

INTRODUCTION: The aim of this survey was to evaluate the qualitative and quantitative relationship among women from Barletta--a national renowned wine center--and their alcohol consumption. METHODS: The AUDIT questionnaire was used to assess the prevalence of alcohol hazardous consumption among women. Questionnaires were submitted from March to November 2012. The sample was composed of 150 women older than 13 years of age, selected by stratified sampling based on age group. RESULTS: 107 women were enrolled with a total response rate of 71.3%. 62% of enrolled women consumes alcoholic beverages with a frequency that goes from 2-3 times a week to less than once a month, usually 1 or 2 alcoholic units. The binge-drinking was reported by 5% of women. Women who reported alcohol-related risk behaviors were less than 3%, they were single and between 18 and 60 years old and such behaviors occur less than once a month. The final score, calculated for all the women from their questionnaire answers, was not higher than 8, with an average score of 1.3 (SD = 1.5; range: 0 to 2.8). The comparison of the average scores of the three age groups showed a statistically significant difference (F = 5.8, p = 0.004). DISCUSSION: Data from literature showed a change in the habits of alcohol intake by the global, European and also Italian population. These changes also affect and involve female. Our study found a quite moderate alcohol consumption among women from Barletta, with only 1% who consumes 3 or more alcohol units and drink more than four times a week and 3% who had hazardous behavior related to their alcohol consumption. Statistical significance was found for the age and the lack of stable relationships. The analysis of characteristics of at risk women (old age and single-status) suggests that much attention should be paid to them and they should represent the main subject of future social interventions to prevent alcohol related problems in the city of Barletta.