Serum concentrations of brain-derived neurotrophic factor and mental disorders in imprisoned women

Objective: Mental disorders and early trauma are highly prevalent in female inmates. Brain-derived neurotrophic factor (BDNF) plays an important role in learning, memory processes, and mood regulation. The aim of this study was to evaluate the relationship between serum BDNF levels and mental disorders among imprisoned women as compared with age- and education-matched controls. Methods: A consecutively recruited sample of 18 female prisoners with mental disorders was assessed for sociodemographic, criminal, and clinical variables using standardized instruments, the Mini International Neuropsychiatric Interview Plus (MINI Plus), and serum BDNF levels. Results: High rates of childhood sexual abuse and posttraumatic stress disorder (PTSD) were found in the group of forensic patients. Serum BDNF levels in the forensic group did not differ from those of healthy controls, and were significantly higher when compared with those of women with mental disorders hospitalized in a general hospital. Conclusion: Elevated serum BDNF levels were found in imprisoned women. The results of this study may suggest neurobiological mechanisms similar to those seen in previous clinical and preclinical studies showing the involvement of BDNF in the pathophysiology of PTSD. .

Public health system and psychiatry in the treatment of 'dangerous' young offenders in Brazil.

We describe the Experimental Health Unit, a special forensic mental health facility in Brazil, created by court order and administered by the São Paulo Department of Health. It was designed for young offenders receiving compulsory inpatient treatment for severe personality disorders. All nine patients admitted to date came from Foundation CASA (a socio-educational centre of assistance for adolescents, the juvenile correctional centres managed by the São Paulo state Department of Justice). The court decision is questionable, relying on a new interpretation of the Child and Adolescent Statute and the law that regulates psychiatric treatment in Brazil. The public health system and psychiatry have been supporting the isolation of some individuals from society, based on the seriousness of their crimes and possession of particular personality characteristics. The decision to commit and send a small group of personality disordered individuals to this unit as inpatients is an unfair decision, since jails and correctional centres hold a high number of psychopathic who have also committed barbaric crimes. The central mental health issue is the role that the public health system should play in the custody of dangerous people; the cost-effectiveness of this model, the accuracy of risk assessment and tractability of people with severe personality disorders are also debatable. From a legal perspective, the operation of this facility raises questions about age of legal majority, the maximum period of incarceration of young offenders and use of whole-life sentences for certain types of crimes and criminals in Brazil.

Serum concentrations of brain-derived neurotrophic factor and mental disorders in imprisoned women.

OBJECTIVE: Mental disorders and early trauma are highly prevalent in female inmates. Brain-derived neurotrophic factor (BDNF) plays an important role in learning, memory processes, and mood regulation. The aim of this study was to evaluate the relationship between serum BDNF levels and mental disorders among imprisoned women as compared with age- and education-matched controls. METHODS: A consecutively recruited sample of 18 female prisoners with mental disorders was assessed for sociodemographic, criminal, and clinical variables using standardized instruments, the Mini International Neuropsychiatric Interview Plus (MINI Plus), and serum BDNF levels. RESULTS: High rates of childhood sexual abuse and posttraumatic stress disorder (PTSD) were found in the group of forensic patients. Serum BDNF levels in the forensic group did not differ from those of healthy controls, and were significantly higher when compared with those of women with mental disorders hospitalized in a general hospital. CONCLUSION: Elevated serum BDNF levels were found in imprisoned women. The results of this study may suggest neurobiological mechanisms similar to those seen in previous clinical and preclinical studies showing the involvement of BDNF in the pathophysiology of PTSD.

Mental health law in Brazil.

Brazil is a Federal Union which comprises 27 member states, one Federal District, and about 5000 municipalities. According to the Federal Constitution (Constituição da República Federativa do Brasil; Diário Oficial da União, 05/out/1988), the competence to rule over health issues is shared by all of them. So, in each part of the country three levels of legislation apply: federal, state and local law. However, as an inferior level of law must not conflict with a superior one, there is a relative uniformity throughout the country, at least in theory. Regarding actual mental healthcare delivery, there are many differences across the Brazilian regions, mostly due to socioeconomic variation.

Sexual disorders and crime.

PURPOSE OF REVIEW: Highlighting the relationship between sexual disorders and crime, reviewing and summarizing the articles published throughout 2011 which add to the current knowledge on this subject. RECENT FINDINGS: Studies on specific populations confirm the association between sexual disorders and crime, particularly between paraphilias and sexual crimes regarding male offenders. Female offenders are less likely to be diagnosed with a sexual disorder. Some case reports focus on unusual paraphilias and lead us to question the vast possibilities of paraphilic contents and sexual arousal patterns. The variations of paraphilic-associated sexual arousal patterns, unconventional sex behaviors or paraphilic disorders are constantly changing. In this sense, the American Psychiatric Association's DSM-5 current proposals for a sexual dysfunction diagnostic category are under intense discussion because of their important clinical and forensic consequences. SUMMARY: Sexual violence is a theme not well understood yet. Because of its nature, researching it can raise many ethical problems. There is no possibility of clinical trials and of case-control studies. Even cohort studies may be problematic in themselves. So, most of the research involves biased samples or case reports, or is merely theoretical. Further research is needed to improve our understanding of the subject, so that preventive and rehabilitative measures can be taken.

Incidência de conduta violenta e antissocial em população psiquiátrica forense / Incidence of violent and antisocial behavior in a forensic psychiatric population

INTRODUÇÃO: As consequências de comportamentos violentos e antissociais de internos em hospitais psiquiátricos são graves e podem determinar prejuízo ao tratamento do agressor. A falta de conhecimento sobre a incidência desse fenômeno e suas características favorece sua perpetuação. OBJETIVOS: Apresentar uma revisão bibliográfica atualizada do tema, informar a incidência de conduta violenta e antissocial em uma população manicomial e descrever a implementação de um método de registro sistematizado desse fenômeno. MÉTODO: A coorte foi selecionada dentro da população de pacientes do Instituto Psiquiátrico Forense Maurício Cardoso (IPFMC). Foi utilizada a Escala de Agressividade Declarada de Yudofsky (Overt Aggression Scale, OAS) e o Questionário de Seguimento de Tengström et al. Durante o período de seguimento de 1 ano, foram avaliados diariamente episódios de conduta violenta e antissocial, registrando-se os mesmos na escala e no questionário. A amostra em estudo foi composta de 68 pacientes homens selecionados de forma aleatória entre a população em cumprimento de medida de segurança no IPFMC. RESULTADOS: A incidência de comportamento violento/antissocial no período estudado foi de 200 episódios, envolvendo 50 pacientes. Houve predomínio de agressões e conduta antissocial durante o dia. As intervenções mais utilizadas foram manejo verbal, isolamento do paciente e aplicação de medicação intramuscular. CONCLUSÃO: Foi possível, pela primeira vez, medir a ocorrência de conduta violenta e antissocial em uma população psiquiátrica forense.

INTRODUCTION: The consequences of violent and antisocial behaviors among psychiatric hospital inpatients are serious and may affect the treatment of the aggressor. Lack of knowledge concerning the incidence of this phenomenon and its characteristics helps perpetuate the current scenario. OBJECTIVES: To present an updated literature review on the topic, to estimate the incidence of violent and antisocial behaviors in a mental hospital population, and to describe the implementation of a systematic method to record this phenomenon. METHOD: A cohort was selected among the psychiatric inpatients at Maurício Cardoso Forensic Psychiatry Institute (Instituto Psiquiátrico Forense Maurício Cardoso, IPFMC). Yudofsky's Overt Aggression Scale (OAS) and Tengström et al.'s Follow-Up Questionnaire were used. During a 1-year follow-up period, episodes of violent and antisocial behavior were evaluated daily and recorded on both the scale and the questionnaire. The population sample included 68 male patients randomly selected among the committed inpatients at IPFMC. RESULTS: The incidence of violent/antisocial behavior along the period assessed was 200 episodes involving 50 patients. Aggressions and antisocial behavior occurred mainly in daytime. The interventions most commonly used were verbal management, patient isolation, and intramuscular medication. CONCLUSION: For the first time, the occurrence of violent and antisocial behavior was measured in a forensic psychiatric population.

Mental disorders in prisons.

PURPOSE OF REVIEW: The existence of people with mental disorders in prisons is a reality found worldwide. The purpose of this article is not only to review the publications on this subject in 2009 but also to stimulate discussions that could contribute to its further scientific study. RECENT FINDINGS: Most studies published in 2009 related to drug use among inmates and its consequences made it clear that this kind of disorder has a closer relationship with the crime than with mental illness. SUMMARY: The existence of the mentally ill in prisons is a complex issue and the studies attempt to analyze aspects such as the type of disorder, sex of criminals, the opposition between incarceration and treatment, policy, harm reduction and stigma. A further study on the variables raised in this work is required, as well as examining others, to the extent that they are relevant to the various socio-economic and cultural realities.

Ethics in forensic psychiatry.

PURPOSE OF REVIEW: Ethics in forensic expertise has been the focus of important debates. After providing a brief history of the theme, a review is given of the articles published in the last 2 years. As this field is constantly changing, it is possible to identify significant differences and even opposing positions adopted till now by various researchers. RECENT FINDINGS: The review includes a discussion on the current ethical theories applied to the forensic field, the objective and subjective issues involved in forensic work, the care needed to prevent additional and unnecessary suffering to the examinees and, finally, future directions as indicated by the authors. SUMMARY: The authors conclude that the discussion on the ethics of forensic expertise should be more comprehensive. The debate should include the search for equilibrium between objectivity and subjectivity, inherent to forensic expertise work, and also the utilization of advanced technological resources, always bearing in mind the conditions to which the examiner and examinee are subjected.

[Forensic psychiatry ethics: expert and clinical practices and research on prisoners]. / Etica em psiquiatria forense: atividades pericial e clínica e pesquisa com prisioneiros.

OBJECTIVE: Review the most relevant ethical issues of the tripartite aspects on which forensic psychiatry is based: expert activity, treatment of the mentally ill in prisons, and research on prisoner subjects. RESULTS AND DISCUSSION: The principles of General Medical Ethics and those of Forensic Medical Ethics are discriminated and confronted and the steps the psychiatrist should take both as an expert and as a clinician to follow the ethical principles of his profession are indicated. A succinct résumé of the research on prisoners is offered and the basic principles, which, if respected, would keep a balance between the need for carrying out research in prisonal environments and the safeguard of prisoners' rights are suggested. CONCLUSION: It is fundamental for the forensic psychiatrist the knowledge and implementation of the ethical principles that govern his practice so that he will effectively respect the basic rights of the individuals he treats or researches with.

Ética em psiquiatria forense: atividades pericial e clínica e pesquisa com prisioneiros / Forensic psychiatry ethics: expert and clinical practices and research on prisoners

OBJETIVO: Revisar as questões éticas mais relevantes do tripé que compõe a base da prática psiquiátrica forense: a atividade pericial, o tratamento de doentes mentais nas prisões e a pesquisa com sujeitos prisioneiros. RESULTADOS E DISCUSSÃO: Distinguem-se e confrontam-se os princípios da Ética Médica Geral com os da Ética Médica Forense e indicam-se os cuidados que o psiquiatra, tanto na função de perito quanto na de clínico, deve tomar para que os preceitos morais de sua profissão sejam observados. Faz-se, também, breve apanhado histórico da pesquisa com prisioneiros e indicam-se princípios básicos que, se respeitados, possibilitariam um equilíbrio entre a necessidade de realização de pesquisa em ambientes prisionais e a proteção dos direitos dos detentos. CONCLUSÃO: É essencial ao psiquiatra forense o conhecimento e observância dos princípios éticos que regem sua prática para que possa efetivamente respeitar os direitos básicos das pessoas que avalia, trata ou pesquisa

OBJECTIVE: Review the most relevant ethical issues of the tripartite aspects on which forensic psychiatry is based: expert activity, treatment of the mentally ill in prisons, and research on prisoner subjects. RESULTS AND DISCUSSION: The principles of General Medical Ethics and those of Forensic Medical Ethics are discriminated and confronted and the steps the psychiatrist should take both as an expert and as a clinician to follow the ethical principles of his profession are indicated. A succinct résumé of the research on prisoners is offered and the basic principles, which, if respected, would keep a balance between the need for carrying out research in prisonal environments and the safeguard of prisoners' rights are suggested. CONCLUSION: It is fundamental for the forensic psychiatrist the knowledge and implementation of the ethical principles that govern his practice so that he will effectively respect the basic rights of the individuals he treats or researches with

Saúde mental e cuidados primários no sistema penitenciário / Mental health and primary care in penitentiary system

Os autores descrevem a organização do Sistema Penitenciário do Rio Grande do Sul, que compreende 11.000 detentos. Tem um Manicômio Judiciário com finalidade de atender prisioneiros com doenças mentais à época do delito ou que vieram a surgir durante o cumprimento de pena (superveniência de doença mental - SDM). Apontam os efeitos sobre o número de internações por SDM após a criação de um serviço de psiquiatria junto à maior penitenciária do Estado, o Presídio Central de Porto Alegre (PCPA). Constataram que, no período em estudo, houve aumento de 11 por cento tanto da população carcerária total do Estado, quanto da do PCPA, porém o número de internações no Manicômio Judiciário, por SDM, cresceu 40 por cento. Observaram, porém, diminuição significativa no número de internações por SDM de prisioneiros oriundos do PCPA (de 23,06/10.000 para 14,64/10.000, com redução de 36,51 por cento), o que demonstra a efetividade do novo serviço psiquiátrico

Saude mental e cuidados primarios no sistema penitenciario

Os autores descrevem a organizacao do Sistema Penitenciario do Rio Grande do Sul, que compreende 11.000 detentos. Tem um Manicomio Judiciario com finalidade de atender prisioneiros com doencas mentais a epoca do delito ou que vieram a surgir durante o cumprimento de pena (superveniencia de doenca mental - SDM). Apontam os efeitos sobre o numero de internacoes por SDM apos a criacao de um servico de psiquiatria junto a maior penitenciaria do Estado, o Presidio Central de Porto Alegre (PCPA). Constatam que, no periodo em estudo, houve aumento de 11 por cento tanto da populacao carceraria total do Estado, quanto da do PCPA, porem o numero de internacao no Manicomio Judiciario, por SDM, cresceu 40 por cento. Observaram, porem, diminuicao significativa no numero de internacoes por SDM de prisioneiros oriundos do PCPA (de 23.06/10.000 para 14.64/10.000, com reducao de 36,51 por cento), o que demonstra a efetividade do novo servico psiquiatrico.