Between psychopathy and deviant socialization: A close look at the mafia men.

The Italian mafia organizations represent a subculture with values, beliefs and goals that are antithetical to and undermining of the predominant society. The conduct of individual members includes such extreme violence for material gain, it may at least superficially suggest a severe personality disorder. Since the first edition of the DSM and into the 21st century, various terms have been used, sometimes interchangeably, but over time inconsistently, to designate the mentality and practices of mafia members. Only recently has the psychology of mafia members become a focus of serious scientific study. Following broader national multicenter research, the present study aimed at investigating the possible differences in psychopathy between those mafia associates who had been convicted only of mafia association (Group A, bosses), and those who were also convicted of violent crimes (Group B, soldiers). The Psychopathy Checklist-Revised (PCL-R) was administered to n = 48 male inmates convicted of mafia association (Mage 45.0 years, SD 10.9, range 20-80 years); Group A consisted of n = 26 (54%) subjects, Group B n = 22 (46%). Most of the sample (73%) did not manifest psychopathy (PCL-R ≥ 25) nor Mann-Whitney U test disclosed significant differences in the total PCL-R scores between the study groups. We found significantly higher scores of PCR-R factor 1 (interpersonal / affective) in the members of the mafia association also convicted of violent crimes (PCL-R F1, group A: 5.8 ± 3.7; group B: 7.9 ± 3.5; p < 0.05), this difference appeared explainable on the basis of a higher component of affective psychopathy. These initial results add to the limited literature on mafia and psychopathy and seem to suggest the existence of a specific component of psychopathy in the subgroup of mafiosi with overtly violent conduct.

The psychopathic dimension in women of mafia.

The authors focus their interest on the socially deviant mafia world, especially on the question of a psychopathic dimension of individuals in mafia. From the scientific point of view this continues to be an unknow world. In all these cases, individuals in mafia, their "feats", their profiles seem to correspond to popular conceptions of the psychopath. Even less known is the women's role in criminal organizations. Their historical role in recent decades has gradually shifted and become more important than it was in the past. The investigators' interest was focused on identifying the prevalence of the psychopathic dimension in mafia women. So the authors examined a sample of 20 convicted mafia women coming from Campania and Calabria, the regions of Camorra and 'Ndrangheta respectively, historical Italian criminal organizations. These women inherited their roles from previous bosses and successfully carried on the criminal business. The authors compared this sample of mafia women with a sample of female offenders with full criminal responsibility who were in common female prisons. Like men of mafia, the women of mafia have a low prevalence of the psychopathic dimension. Further research is necessary to identify the psychopathic dimension in larger samples of women, and then compare them with similar male samples.

Women and Men who Committed Murder: Male/Female Psychopathic Homicides.

The present study was designed to compare gender differences in psychiatric diagnosis with the dimension of psychopathy in women and men who had attempted or committed homicide. The study samples consisted of 39 homicidal females and 48 homicidal males who were confined in one of Italy's REMS or prison facilities in two southern provinces of Italy (Puglia and Basilicata). Assessment instruments included the SCID-5, the PID-5 IRF, and the PCL-R. Each gender group was stratified according to the level of criminal responsibility for the homicidal offense (full, partial, absent), and after assessments, according to the degree of the psychopathic dimension. There were clear gender differences in homicidal individuals. Female offenders were less likely to have had a record of criminal charges/convictions or imprisonment, and their homicides were more often intrafamilial, victimizing especially of their children, whereas males targeted intimate partners and extrafamilial victims. In the entire group, there was an inverse relationship between the level of psychopathy and the personality disorder on one side, and the psychotic disturbance on the other. Factor 2 (lifestyle/antisocial dimension) of the PCL-R was higher among the homicidal males, whereas females tended to score higher on Factor 1 (the interpersonal/affective dimension). Finally, if the psychopathic dimension is a qualifier for antisocial personality disorder, as indicated in DSM-5, this appears to be less true for females who tend to have other personality disorders.

Psychopathy and Female Gender: Phenotypic Expression and Comorbidity; A Study Comparing a Sample of Women Hospitalized in Italy's Maximum Security Facility with Women Who were Criminally Sentenced and Imprisoned.

Various studies have shown that women with psychopathy tend to commit crimes that are less violent than those of psychopathic men. The present study was designed to address the influence of psychopathy on the crimes committed by female offenders. A national sample of female offenders found NGRI or of diminished responsibility and at risk for criminal recidivism (OPG patients) was compared with a sample of female offenders who were convicted and imprisoned. Results of this comparison between the two groups of female offenders indicate that psychopathy is a transversal psychopathological dimension which may or may not be associated with other mental disorders. In both samples, the most commonly reported offenses among women with high PCL-R scores were minor offenses, not particularly violent, but they appear to be related to typical psychopathic features such as superficial charm, pathological lying, and manipulation.

Tracking Psychopathy in Female Italian Inmates: The Role of the DSM-5 Alternative Model of Personality Disorders Dysfunctional Personality Domains.

OBJECTIVE: The present study aimed at testing the relationships between measures of psychopathy and measures of the DSM-5 Alternative Model of Personality Disorders (AMPD) domains in a sample of female offenders who were serving their sentences in Italian prisons. METHOD: Thirty-eight Italian adult female inmates were underwent the Italian versions of the Psychopathy Checklist-Revised (PCL-R) and of the Personality Inventory for DSM-5-Informant Report Form (PID-5-IRF). RESULTS: According to MM robust regression analysis results, high scores on the PID-5-IRF Disinhibition domain scale and low scores on the PID-5-IRF Anxiousness trait scale were significant and substantial predictors of the PCL-R total score. CONCLUSIONS: As a whole, our findings support the hypothesis that assessing the DSM-5 AMPD domains (and traits) may be important for tracking psychopathy in female inmates.

Female Residents with Psychopathy in a High-Security Italian Hospital.

Before its closure on April 1, 2015, the Castiglione delle Stiviere was the only maximum-security hospital in Italy that admitted women. In this context, the investigators examined factors related to psychopathy that were thought to be gender specific. Several prior investigations have reported a significant correlation between psychopathy and borderline personality disorder, a disorder thought to represent the phenotypical expression of psychopathy in women. The purpose of this research was to identify psychopathological and phenotypical gender-specific factors that are associated with psychopathy in women. The data appear consistent with that found in the recent international literature and also highlight the different phenotypical manifestation of psychopathy in the two genders. Whereas in males psychopathy is associated with antisocial personality disorder, in females psychopathy is associated with borderline personality disorder.

Qualitative analysis of the capacity to consent to treatment in patients with a chronic neurodegenerative disease: Alzheimer's disease / Analisi qualitativa sulla capacità a prestare consenso al trattamento in pazienti con malattie cronico degenerative neuropsicoorganiche: Demenza di Alzheimer.

OBJECTIVE: Informed consent is an essential element in doctor-patient relationship. In particular, obtaining valid informed consent from patients with neurocognitive diseases is a critical issue at present. For this reason, we decided to conduct research on elderly patients with Alzheimer's disease ( Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) to assess their capacity to make treatment decisions. METHODS: The experimental group comprised 70 Alzheimer patients who were admitted to the Neurodegenerative Disease Unit of the University of Bari. The control group consisted of 83 elderly patients without neurocognitive disorders who were hospitalized in the Geriatric Unit at the same university. After providing written consent to participate in the research, each subject underwent the following assessments: (a) assessment of comprehension sheet, (b) Neuropsychiatric Inventory (NPI) and Global Functioning Evaluation (GFE), (c) neurological evaluation, (d) neuropsychological assessment with a full battery of tests, (d) The MacArthur Treatment Competence Study (MacArthur Competence Assessment Tool for Treatment (MacCAT-T); understanding, appreciating, reasoning and expressing a choice) and (e) a semi-structured interview administered by the patient's caregiver. RESULTS/CONCLUSION: The present survey was designed to analyze possible qualitative and quantitative correlations between cognitive functioning and capacity to consent in relation to different degrees of severity of the neurodegenerative disorder. A large portion of the patients in our experimental sample did not appear to have the capacity to provide a valid consent. The authors present initial results of this study and discuss their possible implications.

[Mental capacity and capacity to consent: multicentric study in a involuntary psychiatric hospitalized patients sample]. / Mental capacity e capacity to consent: studio multicentrico in un campione di pazienti ricoverati in TSO.

BACKGROUND: The purpose of this longitudinal observational study is to evaluate the course and impact of clinical, social, and behavioral variables on the involuntary readmission of psychiatric patients, during a 6-months follow-up after discharge from a prior involuntary hospitalization. METHODS: N=131 involuntarily committed psychiatric patients were enrolled in three university hospitals (Bari n=57; Perugia n=42; Rome n=32). At the first assessment cognitive functioning (MMSE), psychiatric symptoms severity (BPRS-E), capacity to consent to treatment (MacCAT-T) as well as principal socio-demographic and clinical variables were collected. At 6-months follow-up, we collected data concerning involuntary psychiatric readmissions, pharmacotherapy adherence, new deliberate self-harm or harm to others as well as having been legally prosecuted. RESULTS: N=120 patients were reevaluated at follow-up (M=188 days, SD=12.6); among these n=15 (12.5%) have had a new involuntary psychiatric admission due to an acute mental disorder. Re-hospitalized patients showed higher rates of harm to others (p<0.05) and legal prosecution (p<0.05); there was moreover a trend toward higher pharmacological dropout rates in involuntarily rehospitalized patients. We found no differences between the two groups in baseline psychiatric symptoms severity and cognitive functioning, whereas involuntary re-hospitalization was associated with more frequent involuntary hospitalization during last year (p<0.05) and higher MacCAT-T reasoning (p<0.05). CONCLUSIONS: Involuntary psychiatric readmission rates proved to be poorly associated with clinical features assessed during previous hospitalization. Our data suggest that social and legal factors, including those connected to patients' dangerousness, could play a role also in a civil commitment system based solely on the need for treatment.

Approach to the patient hospitalized during the Muslim Ramadan: bioethical and clinical considerations.

Multi-ethnicity has been persuading the healthcare professionals to increasingly learn new tools in terms of cultural and social skills, in order to cope with a diversified variety of patients. The coexistence of different cultures in Italy can be found in the migration flows over the last few decades. The cohabitations between individuals with different ethnicity in our territory has led the health professionals to address some anthropological, moral, religious and political issues implied in populations and cultures different from ours. Clinical literature has made us aware of the importance of correct communication between doctor and patient in order to determine the diagnostic-therapeutic plan, especially in the patients with a foreign origin due to the linguistic and intercultural differences implicated. In an emergency condition, it may occur to cure the patients neglecting their cultural identity and, in so doing, to create misunderstandings that, in turn, can lead to a lack of human relationship and frustrate the therapeutic project. An example is the treatment of Muslim people. The authors, through the description of a case observed during Ramadan, analyze the variables applying to the therapeutic decision making process.

[ADHD and illegal conduct: a survey in Juvenile Justice Services in Puglia]. / ADHD e comportamenti antigiuridici: un'indagine presso i Centri di Giustizia Minorile della Regione Puglia.

OBJECTIVE: The aim of our study was to identify possible risk factors related to carrying out of illegal conducts by minors on their first offense, and any individual variables, family, economic and socio-cultural related to phenomenon also investigated. MATERIALS AND METHODS: The longitudinal study involved the acquisition of a series of biographical information, family, school, behavioral and clinical characteristics of children on their first crime recruited over a year in Puglia Region. For its purpose the study involved the use two standardized clinical scales (Youth Self-Report and Conners Adolescent Self Report Scale). For over a year we proceeded to follow-up. RESULTS: The survey revealed some variables family, social and school related to antisocial behavior of children in their first contact with the judicial authorities. CONCLUSIONS: The results confirm the need for primary and secondary prevention of children at risk through mutidisciplinary, early, selective interventions.

Psychopathology, symptoms of attention-deficit/hyperactivity disorder, and risk factors in juvenile offenders.

BACKGROUND: The aim of this study was to assess the prevalence of potential environmental and psychopathological risk factors, with special focus on symptoms of attention-deficit/hyperactivity disorder (ADHD), in a sample of adolescent offenders in relation to the type of crime committed. METHODS: The assessment included data collection and administration of clinical standardized scales such as the Youth Self-Report and Conners' Adolescent Self-Report Scale. A total of 135 juvenile offenders participated in the study. In relation to the type of crime committed, we identified three groups matched for age and sex (crimes against people, property crimes, and alcohol-drug-related crimes). RESULTS: Fifty-two percent of juvenile offenders reported educational achievement problems and 34% reported a family history of psychiatric disorders. We detected a statistically significant difference between the three groups with regard to ADHD (P=0.01) and conduct problems (P=0.034). Juvenile offenders who had committed crimes against people showed more ADHD symptoms (18%) and conduct problems (20%) than adolescents who had committed property crimes and alcohol-drug-related crimes. Sixty percent of the juvenile offenders who had committed property crimes and 54% of those who had committed alcohol-drug-related crimes showed problems in academic achievement. CONCLUSION: These findings suggest the need to implement specific interventions for prevention and treatment of specific criminal behavior.

Women victims of violent partners: the Italian situation amid culture and psychopathology.

In 2006, the Italian National Institute of Statistics (ISTAT) conducted a survey over the entire national territory of women victims of sexual, physical, and psychologic violence, a few years after the first survey, conducted in 2002. For the 2002 survey, respondents were 60,000 women, 22,759 of whom were aged 14­59 years. For the 2006 survey, the sample consisted of 25,000 women aged 16­70 years. Owing to the sensitivity of the issues, the telephone survey technique seems best suited because it provides more anonymity and guarantee of protection. The survey showed that the phenomenon of violence against women is most commonly perpetrated by the partner or ex-partner, even in cases of homicide. A comparison of the Italian data with those of the U.S.A. for the period 2001­2006 showed a specificity of Intimate Partner Violence in Italy, that seems to be related to cultural elements and psychologic and psychopathologic factors.

The "Bestie di Satana" murders.

In recent years, satanic groups have been responsible for various types and degrees of crimes. We report the case of a number of murders committed in Italy by a group of young people calling themselves the "Bestie di Satana". Forensic psychiatric assessment of the members of a satanic sect charged with the crime revealed that all the young people had a fragile, immature personality, a very low level of education and were socially disadvantaged. The trial of the members of the "Bestie di Satana" sect was concluded with the verdict of deliberate murder, and all the members were given long jail sentences. This report should lead us to explore social and cultural responses to juvenile satanism, statistically shown to be a relatively rare phenomenon but with a high criminal potential.

Female same gender stalking: a brief review of the literature and case report.

The authors analyze a rare case of female same gender stalking that came to their observation as forensic psychiatry experts. Despite previously only heterosexual experiences, the woman, who was 30 in 2002, had three intimate same gender relationships in succession from 2002 to 2009: she broke off with each woman in order to take up with another. When she separated from the third woman she began violent persecutory behavior against her, in the form of harassment coming under the heading of stalking, and was reported to the authorities. In treatment with SSRI since 2003 for an anxiety disorder with panic episodes, she had been taking the drugs irregularly during the stalking period. At the end of the third relationship, after she had violently attacked her girlfriend she was advised by her family to present to a Hospital center in Northern Italy. There, she was diagnosed with a "Narcissistic Paranoid Personality Disorder", and it was hypothesized that the SSRI she was taking could have induced hypo/manic episodes and disinhibition in the woman, who had previously been heterosexual. At this hospital, mood stabilizers were prescribed. The defending lawyer therefore applied for a forensic psychiatry assessment, claiming that the persecutory behavior against the third girlfriend was induced by taking SSRI. In Italy the penal code specifies the recognition of abolished or diminished liability for crimes if a correlation between the mental disease and the crime can be demonstrated, if the disease was in course at the time of the crime, and if the motives behind the crime and the disease can be shown to be linked. In short, if the crime can be shown to be a symptom of the disease. But the forensic psychiatry assessment demonstrated that despite the presence of some factors of a psychopathological nature, the motives underlying the harassment were attributable to the woman's existential history and personality structure rather than to psychopathological causes. She was therefore judged guilty of the crime of stalking and a plea for a reduced sentence was granted. In this case, the gender of the stalker and victim seemed to be irrelevant.

Cannabis use and violent behaviour: a psychiatric patients cohort study in Southern Italy.

UNLABELLED: An ample volume of research evidence supports the conclusion that drug use/abuse is correlated with violent behavior. Some studies have shown that co-morbidity also appears to be predictive of violent behavior. The research evidence indicates gender differences, while socio-economic and familial factors play a role, too. METHOD: We conducted a retrospective study of the clinical files of four public psychiatric outpatient facilities during five years. The objectives of the research were to identify and analyze relationships between: a) cannabis use/abuse and violent behavior and b) cannabis use/abuse, psychopathology, and violent behavior. The study sample consisted of 1,582 subjects. The data, gathered in a dedicated database, were processed by applying univariate and multivariate analysis models. RESULTS: Subjects who used/abused cannabis showed a high prevalence of violent behavior, Regardless of the type of psychiatric disorder, the use of cannabis appears to be an evident risk factor. Significant correlations also emerged between cannabis use/abuse and the type of violent behavior, especially self-inflicted injury. Evidence also emerged that other factors are implicated. This is consistent with the current literature proposing multi-casual explanations of violent behavior.

Coexistence and independence between a mental disorder and female stalking.

There are few studies of female stalkers in literature addressing different study populations. There appears to be a high incidence of mental disease among female stalkers, having an important role in inducing the harassment. We present a woman affected by a bipolar disorder who had a long affair with her victim, broken off in 2007. Stalking began in January 2009 and continued for 6 months, during which time she was not taking drugs and was in a decompensated clinical phase. In July 2009, she was denounced for harassment; the authorities demanded a psychiatric examination. The woman then resumed taking the medication regularly. In December 2009, although she was in complete remission, she began stalking once more. This case shows that even when there seems to be an evident relation between psychopathology and crime, it is always necessary to evaluate to what extent the mental disorder is responsible for the criminal behavior.

[ASO-TSO, emergency interventions: has anything changed? Old and new psychiatrist's professional responsibilities]. / ASO, TSO, interventi d'urgenza: è cambiato qualcosa? Vecchie e nuove responsabilità professionali dello psichiatra.

The Law 833 of 1978 on the subject of psychiatric emergency treatments in absence of consensus has contributed to grant mental patients equal guaranties and equal constitutional rights which, until that moment, they had been denied. This standpoint includes TSO in favor of mental patients. Ordered by the constitutional laws which guarantee a person's inviolable rights, TSO finds itself positioned between individual freedom and the freedom of treatment on the one hand, and the right to safeguard health on the other hand. The procedure of TSO is noticeable in its various phases so as to provide for the various levels of safeguarding a person who is temporarily deprived of the capacity to express valid consensus. On the other side it also has a certain amount of flexibility in its application, which guarantees adaptability of the norm in various contexts and various incidental situations. Nevertheless, the complexity of the law on TSO, as well as the interpretation margins of the procedure have contributed to the creation of an application frame which is not free of criticism. In this context, the recommendations of the Conference of Regions and Autonomous Provinces have particular importance. These recommendations deserve careful analysis, both for the presence of elements of novelty (in the very particular cases of TSO for children under 18 and TSO for decisionally impaired subjects) and for the reminder of the full application of "non-hospitalized TSO". The latter was provided for in Law 833/78 but has never been adequately and completely adopted because it has never been explained in its concrete applicability. Therefore, bearing in mind the already known responsibility of a psychiatrist in an emergency case, and with renewed interest in new medical performance a psychiatrist of public service has to guarantee, we are preparing to give our contribution on the subject of professional obligations at a historical moment in which known trials seem to assign the responsibility for the "dangerousness" of a mental patient to the psychiatrist.

[Evaluations for informed consent for various long-term psychiatric treatments]. / La valutazione del consenso informato alle cure quale variabile del trattamento psichiatrico.

OBJECTIVES: The study was created with two distinct objectives: the first, an investigation into the quality of informed consent in patients assited by the mental health department for the Region of Puglia. The second, to look at the possibility of implementing a systematic use of tested monitoring of the daily practices of the psychiatric services. METHODS: The use of the structured MacCAT-T (modified) interview was implemented. The interview was carried out on 708 patients across all areas of the mental health deparment for the Region of Puglia: 77 SPDC patients, 336 outpatients and 295 patients residing in rehabilitation centres. RESULTS: 31.2% of patients voluntarily hospitalised in SPDC did not know the motivations for their hospitalisation. 46.1% of patients in rehabilitation centres were also unaware of the reasons for their stay. Further problems arose in data regarding the prognosis of the disorders: 62.3% of SPDC patients, 65% of patients in rehabilitation centres and 39% of outpatients coud not describe the prognosis of their disorder. DISCUSSION: As a result of the study, the authors therefore propose: consensus monitoring through a standardised method providing targets for service improvement. The monitoring however, must be made integral in the daily activities of clinical observation. Applying the practice of consent evaluation would provide adequate support in requiring then suitable methods of legal protection, such as administrative support, which could then aid in creating correct legal continuity in treatment.