Metabolic syndrome in patients who have been subjected to isolation security measures and treated with atypical antipsychotics. / Zespól metaboliczny u pacjentów realizujacych izolacyjny srodek zabezpieczajacy, leczonych atypowymi lekami przeciwpsychotycznymi.

OBJECTIVES: The main aim of the study was to assess the incidence of metabolic syndrome and its individual components in patients subject to a confinement measure, treated with antipsychotics in mono - or polytherapy. Additional objectives included the analysis of associations between the occurrence of metabolic syndrome and patients' age, psychiatric diagnosis, overweight or obesity, and the presence of addictions to psychoactive substances. METHODS: The study involved 61 patients of the Department of Forensic Psychiatry, including 9 women and 52 men, subject to a confinement measure from September 2019 to August 2021. All parameters of metabolic syndrome and BMI were measured twice, at the beginning of the stay at the Department and after six months of treatment with atypical antipsychotics. Appropriate statistical comparative analyses were then performed. RESULTS: There was no relationship between the occurrence of metabolic syndrome and the age of the subjects, medical diagnosis, addiction to psychoactive substances, including smoking. It has not been confirmed that the chronic use of atypical antipsychotics with parallel prophylactic and health-promoting effects in conditions of confinement leads to the development of metabolic syndrome and worsens its symptoms, apart from a marked increase in waist circumference and an increase in BMI. CONCLUSIONS: Systematic measurements of BMI and waist circumference during treatment with atypical antipsychotics may be accurate tools in assessing the risk of metabolic syndrome. Long-term confinement hospitalizations should include psychoeducational nterventions aimed at minimizing metabolic complications of pharmacotherapy.

Insanity as a consequence of an epileptic seizure and precautionary measures. / Niepoczytalnosc jako nastepstwo napadu padaczkowego a srodki zabezpieczajace.

The analysis covers the case of a driver suffering from epilepsy for many years, who during an epileptic seizure, in a state of profound disturbance of consciousness, caused a road accident. Such situations usually result in the perpetrator being considered insane in relation to the allegation. The task of expert psychiatrists and psychologists is then to assess the likelihood of the perpetrator of the prohibited act repeating it, and to indicate to the court the optimal therapeutic precautionary or penal measure. These legal solutions also apply to perpetrators who were considered insane due to disturbances of consciousness occurring in the course of various somatic diseases, and not permanent mental disorders. Currently, there are no grounds for appointing expert neurologists, diabetologists, cardiologists, pulmonologists, and other specialists who would assess the legitimacy of taking precautionary measures, which may raise judicial doubts. Moreover, applying in such cases only the measures indicated in Article 93a § 1 of the Penal Code does not find any psychiatric and psychological justification. Consideration should be given to extending the catalog of protective measures to include the therapy of various somatic diseases in order to minimize the risk of developing deep mental disorders in the future. The work proposes new opinion-making solutions, which, however, requires changes in legal regulations.

Utility of homicide-suicide constructs in forensic psychiatry. / Uzytecznosc konstruktów opisujacych zabójstwo-samobójstwo w psychiatrii sadowej.

In foreign literature, the term ?dyadic death' is used to describe a situation of a murder followed by the perpetrator's suicide. It differs from the term ?extended suicide' used in Poland. While it is recognized that the occurrence of ?dyadic death' can be caused, apart from mental disorders, by unfavorable environmental factors, ?extended suicide' is equated with the occurrence of severe depressive disorders in the perpetrator. The above-mentioned constructs describing a homicide-suicide were analyzed from the psychiatric and criminological point of view. The study shall discuss a case of a young woman who drowned her young son in a public place, and then declared her suicide intentions. An analysis of the course of mental disorders in the perpetrator, her biological burdens, situational and family conditions was carried out, and the personality factors that led to her mental decompensation were taken into account. Pathological motivational background of the perpetrator of her son's murder was clearly modified by her personality dysfunctions exacerbated by life difficulties. It differed from the motivation of a ?typical' perpetrator of ?dyadic death' or ?extended suicide' presented in the literature. Settlements in cases involving murder and subsequent suicide attempts require a thorough forensic-psychiatric and criminological analysis. In some cases, the terms describing such situations do not refer to the clinical condition of the offender but to the nature and image of the crime. Abuse of these terms may contribute to judicial errors.

Psychological impediments to marriage - forensic and psychiatric opinions. Part I. / Psychiczne przeszkody w zawarciu malzenstwa ­ opiniowanie sadowo-psychiatryczne. Czesc I.

There are two types of proceedings before common courts for annulment of marriages during which expert psychiatrists are appointed. In the first type, the key task of the expert is to assess whether the presence of mental illness or mental retardation at the date of the marriage could possibly pose a threat to the marriage or health of future offspring. The expert performs a retrospective assessment not only of the course and severity of psychiatric disorders strictly distinguished by the legislator, but also their impact on the social functioning of a given person. In the second type of proceedings, marriage annulment is possible when the declaration of conclusion of a marriage was made by a prospective spouse who for whatever reason was in the state that excluded conscious expression of will. The task of the expert in this case is to assess the ability to perform a specific legal act. The aim of the analysis was to discuss problematic and unclear legal formulations concerning marriage annulment, which pose difficulties to psychiatrists and cause that sometimes opinions should only be prepared with a certain probability. Itis particularly troublesome to assess the impactof parent's mental dysfunctions on the health of future offspring. An additional element hindering the forensic and psychiatric evaluation is an analysis of the influence of the environment (including attitudes and behaviours of a healthy spouse) on the picture and the course of mental disorders of an ill or handicapped prospective spouse.

Psychological impediments to marriage - forensic and psychiatric opinions. Part II. / Psychiczne przeszkody w zawarciu malzenstwa ­ opiniowanie sadowo-psychiatryczne. Czesc II.

Episcopal courts adjudicate in proceedings for declaring a marriage void and in these cases psychiatrists and psychologists are appointed as experts. Expert judgment requires the expert to follow a specific substantive approach when preparing the expertise, as well as knowledge of canon legal provisions. Canon law makes validity of a relationship dependent on fulfilment of premises of a valid marriage at the time of the marriage, thus accepting the possibility of an invalid marriage. The so-called consensual and indirectly mental incapacity to marry is dealt with in canon 1,095, which says that the following are incapable of contracting marriage: (1) those who lack the sufficient use of reason; (2) those who suffer from a grave defect of discretion of judgment concerning the essential matrimonial rights and duties mutually to be handed over and accepted; and (3) those who are not able to assume the essential obligations of marriage for causes of a psychic nature. Episcopal courts use terminology that is not found in psychiatry or clinical psychology. However, specific psychopathological conditions stand behind specific formulations in the Code, and they should be taken into account by experts in their analyzes. In proceedings before common courts, only mental illness and mental retardation are taken into account, and no specific disorders are mentioned in Church legislation, which means that experts must consider a wide range of mental dysfunctions in their assessments.

Fear of imminent death - use of evidence in forensic-psychiatric expertise. / Obawa rychlej smierci ­ wykorzystanie materialu dowodowego w ekspertyzie sadowo-psychiatrycznej.

In accordance with the Polish civil law, there are at least several ways to dispose of property in the event of death. One of them is a special form of oral testament. The main issue to be determined by the court is to either confirm or deny the existence of fear of imminent death of the testator at the time of bequest. For this purpose, the court uses expert psychiatrists' opinions. The article presents a case of a man in the terminal phase of a malignant disease who used an oral form of bequest. Such cases are relatively rare and therefore the described case is intended to illustrate the complex nature of the expertise. It points to the need for the experts to take into account complex legal regulations, the observance of which stipulates the possibility of using this form of will. Factual assessment of the witnesses' testimony complicates elaboration of the material, as the testimony is generally contradictory. It was proposed that the witnesses' testimony should be sorted out in terms of substance (psychopathology), based on the analysis of the separated research areas. Medical records can be treated not only as a source of information about the dynamics of somatic diseases of the testator and secondary changes in his/her mental state. It can also be a valuable source of knowledge about the testator's attitude to health and disease issues, treatment processes, prognosis, threat to his/her life and death.

Pathological jealousy from forensic psychiatric perspective. / Zazdrosc patologiczna z perspektywy sadowo-psychiatrycznej.

Jealousy is defined as a complex mental state caused by a real or false - imaginary - change in a way of perception of a threat of terminating a valued partnership in favor of a real or imaginary rival. Apart from jealousy demonstrated by mentally disordered people, but without symptoms of mental illness and obsessive jealousy, there is also a psychotic jealousy. One of diagnostic difficulties is to determine when a normal jealousy about a partner acquires delusional nature and the boundary between these two can be difficult to detect, which often is a concern of forensic psychiatrists. A mistake in diagnosis can seriously affect issuing of opinions and can have legal consequences. There are accounts claiming that the emergence of delusional jealousy is a continuous process, from the so-called normal to morbid jealousy. Diagnostic assessments in this matter bring difficulties in juidicial-psychiatric assessments. Delusions of marriage infidelity accompany various psychotic disorders and their foundations can be found in endogenous factors, organic changes in peripheral nervous system and addictions. People demonstrating these types of delusional disorders are extremely dangerous for the environment, not solely because of the presence of psychotic symptoms, but also because of various environmental and relationship-related factors, which contribute to the genesis of their criminal offenses. Making accurate and just forensic psychiatric assessment of this group of offenders concerns risk assessment of offenders, validity of the use of security measures and the type of therapeutic interventions.

Offenses motivated by erotic jealousy committed by mentally healthy people. / Czyny zabronione na tle zazdrosci erotycznej u osób zdrowych psychicznie.

Most often jealousy is treated as a complex mental phenomenon, which consists of changes in emotional state, in cognitive and behavioral spheres, caused by erotic infidelity of a partner or a feeling of insecurity caused by a rival. It is estimated that factors contributing to this are a combination of dynamic affiliative factors, personality traits as well as environmental and social factors. Jealousy can take a reactive, anxious or possessive forms. This paper aims to present multifactorial genesis of jealousy, which leads to aggressive behaviors, usually in a form of domestic violence, but also resulting in homicides. Factors contributing to the occurrence of aggressive behaviors include specific personality traits of perpetrators as well as external variables, often constant and growing conflicts with the environment, usually multiplied by strong negative emotions directly preceding aggressive attacks. Acts motivated by jealousy often cause juridical difficulties in forensic psychiatry, both in the scope of diagnosis, determination of sanity related to the accusation, as well as in validity of the use of security measures. Identification of the nature of different types of jealousy, their dimensions and various conditioning can contribute to apt judicial-psychiatric assessments.

Defendant's or convict's competency to stand trial - forensic psychiatric evaluation.

The purpose of this paper was to draw attention to particularly important aspects of pronouncing forensic psychiatric judgment regarding the accused or convicted individuals' competency to stand trial. The level of a person's mental capacity should be established using a structured psychiatric interview concerning a variety of aspects of a trial. Emphasis should be placed on evaluating the defendant's consciousness of the charges, knowledge of the potential punishment, ability to make significant decisions and be engaged in defense, knowledge about the role that particular people present in the courtroom play, understanding of the meaning of the evidence gathered in the case, the risk of aggression. The analysis should take into account the specificity of the mental disorder, the influence of proceedings on the course of disorder, as well as the presence of reactive disorders. Using testing tools by the expert can facilitate the process of evaluation to a certain degree. Forensic psychiatric evaluations can give rise to difficulties for the experts, what with the changing legal regulations and their interpretations. It would be justified to develop the standards of evaluation in this kind of cases, which would on the one hand apply to experts but which would also be respected by the judicial organ.

Dyadic death - depression and borderline personality.

OBJECTIVES: This work aims to present the difficulties in the assessment of sanity of a perpetrator involved in the so-called dyadic death, which in Poland is identified with the occurrence of sever mood disturbances at the time of the crime. CASE: A case of a man who killed his wife and two children is presented. The perpetrator himself tried to commit suicide by cutting his veins with a razor. COMMENTARY: The authors underline diagnostic difficulties which were encountered in the analysed case, they point out the necessity to go beyond the phenomenological aspect of "dyadic death" and the need for multidimensional clinical evaluation of the perpetrator. The rarity of similar acts and low survival rate of perpetrators leaves experts with relatively small amount of opinion giving experience. Thus, there is a need for high accuracy research and careful consideration.