Characteristics of deaths by suicide in postmortem studies in Brazil: A systematic review and meta-analysis.

INTRODUCTION: Suicide is one of the leading causes of death, with a trend for its increase in Brazil in past decades. This study aimed to review the characteristics of suicides in Brazilian postmortem studies. METHODS: Studies investigating suicide deaths in Brazil, and based on autopsy or psychological autopsy were included. Proportions were pooled across studies with the use of random and fixed effects models. RESULTS: 6777 references were retrieved from six databases (searches up to January, 2023), and 45 studies included. In autopsy studies (k = 37, n = 16,231), substance use at toxicological analysis was found in 36.42% of cases (95% CI: 30.05-43.32), previous suicide attempts in 23.92% (95% CI: 6.73-57.78). In psychological autopsy studies (k = 8, n = 139), previous suicide attempts were reported in 28.09% (95% CI: 19.74-38.28), psychiatric conditions/symptoms in 90.67% (95% CI: 67.79-97.82), family history of suicidality in 21.33% (95% CI: 13.5-32.03). Most suicide deaths were reported in males and took place at the victim's home, hanging was the most frequent suicide method. Included studies presented significant limitations in quality assessment. CONCLUSION: Future studies should present more robust methodology, including bigger samples, the use of controls, and validated methodology.

Gender-related and non-gender-related female homicide in Porto Alegre, Brazil, from 2010 to 2016.

Female homicide is a global phenomenon with a higher prevalence in countries in Asia, Africa, and the Americas. Life expectancy in Brazil is compromised by the high risk of death from male and female homicides, a growing social problem. This study aimed to integrate different public datasets and describe the sociodemographic, criminal, and medicolegal characteristics of the homicides of girls and women occurring in Porto Alegre, southern Brazil, from 2010 to 2016. The data were obtained from autopsy reports, police reports, and records from crime scenes. During this period, there was a significant increase in overall standardized rates of female homicides (4.98 to 10.85), with a pronounced increase in non-gender-related deaths, especially due to urban violence, such as involvement in drug trafficking and other crimes and robbery resulting in death. Young (15-29 years of age), non-White women were the most affected. Increased female homicide rates due to non-gender-related factors is a new and worrying phenomenon in Brazil. Obtaining specific data on the profile of victims and characteristics of violence is a crucial step in facing the problem and directing public policies.

Perspectivas éticas e legais em perícias de psiquiatria forense / Ethical and legal perspectives of forensic psychiatry in expert testimony / Perspectivas éticas y legales en pericias de psiquiatría forense

Resumo Conhecer o paradigma ético que fundamenta o código moral da medicina é fundamental para atuar não só na assistência, mas também em processo pericial. A partir de revisão da literatura, propõe-se avaliar a maneira como os quatro princípios éticos fundamentais (beneficência, não maleficência, autonomia e justiça) se aplicam antes, durante e após a perícia psiquiátrica, como perito ou como assistente técnico. Novos desafios éticos vêm surgindo na psiquiatria forense. Com a pandemia de covid-19, a tecnologia foi adotada para permitir a prática da telemedicina, mas ainda se debate se seria suficiente para promover avaliação pericial psiquiátrica adequada. Considerando a complexidade da área, cada situação deve ser analisada de forma individual e abrangente, sendo recomendável buscar auxílio para debater as perspectivas éticas e legais das perícias psiquiátricas quando necessário.

Abstract Knowing the ethical paradigm that bases the medicine moral code is fundamental to act not only in care but also in the expert testimony process. From a revision of the literature, we propose to evaluate the way the four fundamental ethical principles (beneficence, nonmaleficence, autonomy, and justice) apply before, during, and after the psychiatric expert testimony, be it as expert or as technical assistant. New ethical challenges have been appearing in forensic psychiatry. With the COVID-19 pandemic, technology was adopted to allow the practice of telemedicine, but debates still occur if that would suffice for an adequate psychiatric expert testimony evaluation. Considering the complexity of the area, each situation must be analyzed in an individualized and all-encompassing way and seeking help to debate the ethical and legal perspectives of psychiatric expert testimonies is recommended when necessary.

Resumen Conocer el paradigma ético que subyace en el código moral de la medicina es fundamental para actuar no solo en la asistencia, sino también en el proceso pericial. A partir de una revisión bibliográfica, se propone evaluar cómo se aplican los cuatro principios éticos fundamentales (beneficencia, no maleficencia, autonomía y justicia) antes, durante y después de la pericia psiquiátrica, ya sea como perito o como asistente técnico. Están surgiendo nuevos desafíos éticos en la psiquiatría forense. Con la pandemia del Covid-19, se utilizó la tecnología para permitir la práctica de la telemedicina, pero aún está en debate si esto es suficiente para promover una adecuada evaluación psiquiátrica forense. Considerando la complejidad del área, se debe analizar cada situación de manera individual e integral y, cuando sea necesario, buscar ayuda para debatir las perspectivas éticas y legales de la pericia psiquiátrica.

Association between childhood trauma, parental bonding and antisocial personality disorder in adulthood: A machine learning approach.

Childhood trauma (CT) and parental bonding (PB) have been correlated with later antisocial personality disorder (ASPD). Aiming to better understand this complex interaction we analyzed the data from a cross-sectional study that evaluated 346 male inpatient cocaine users, using both traditional statistical analysis and machine learning (ML) approaches. Childhood Trauma Questionnaire (CTQ), Parental Bonding Instrument (PBI), and Mini International Neuropsychiatric Interview (MINI) were applied. We found a markedly higher prevalence of mental illness in the ASPD group. The ML method and the traditional analysis showed that emotional and physical abuse were the factors with the strongest relationship with ASPD. Also, there were discrepancies between the findings of both methods regarding physical neglect and paternal care. Although this study does not allow definitive answers in this matter, we do propose that these two methods can aid in better comprehending how multiple variables interact with each other in the development of psychological disorders.

Matricide, parricide, and filicide: Are major mental disorders or personality disorders involved? Assessment of criminal responsibility in Brazilian cases.

Violence committed by individuals with severe mental disorders has become a growing focus of interest among physicians, law enforcement officials, and the general population. Homicide involving relatives, specially parricide, matricide, and filicide, despite the relatively low incidence of these crimes, may be enigmatic, so forensic psychiatrist are frequently called on the courts to answer questions about insanity and criminal responsibility. The current study aims to describe Brazilian cases of parricide, matricide, and filicide associated with presence of major mental disorders and personality disorders, discussing the assessment of criminal responsibility in each case. The case series described were specifically related to people with mental illness, as bipolar disorder, schizophrenia, and borderline personality with comorbidity of drug abuse. Two of them were considered not guilty by reason of insanity, and the other one was considered partially criminally responsible, according to Brazilian Law and Forensic Psychiatric Reports of the cases. The justice determined compulsory psychiatric treatment for all of them. The question of criminal responsibility of individuals with mental disorders is challenging for criminal justice, psychiatry, and society. Adequate treatment is mandatory to prevent crimes involving mental disorders, as shown in literature. The verification of criminal responsibility is essential for persons' adequate referral in any system of criminal law, thus protecting human rights and referring those who need psychiatric treatment.

Youth homicide: a study of homicide predictor factors in adolescent offenders in custody in the south of Brazil / Homicídio juvenil: fatores preditores em adolescentes privados de liberdade no sul do Brasil

Abstract Objectives To assess the sociodemographic, psychiatric and criminal profile of adolescent offenders complying with temporary custody for homicide/homicide attempt and to compare it to that of the population of adolescents in custody for other crimes. Methods This cross-sectional study was based on the review of the medical records of 74 juvenile offenders in temporary custody at socioeducational agency Fundação de Atendimento Sócio-Educativo do Rio Grande do Sul. For the analysis, variables that presented p < 0.2 were included in multivariate adjustment through logistic regression. Results The sample comprised males only, mostly with white skin color (55.6 vs. 57.9% for homicidal and non-homicidal, respectively) and with a high prevalence of school failure (77.8 vs. 91.2%). There was a high prevalence of family history of delinquency (88 vs. 81%). Only years of study and belonging or not to a criminal organization remained statistically significant in the multivariate model. Conclusion The results show that having fewer years of study and denying belonging to a criminal organization are predictive factors of homicidal behavior in adolescent offenders (both with statistical relevance). The other variables were not statistically significant for this outcome. The present study may serve as a basis for further research, which may improve our understanding of risk factors for juvenile homicide.

Resumo Objetivos Avaliar o perfil sociodemográfico, psiquiátrico e criminal de adolescentes infratores que cumprem internação provisória por homicídio ou tentativa de homicídio e compará-los aos adolescentes privados de liberdade por outros atos infracionais. Métodos Este estudo transversal baseou-se na revisão dos prontuários médicos de 74 adolescentes infratores em internação provisória na Fundação de Atendimento Sócio-Educativo do Rio Grande do Sul. Para a análise, variáveis que apresentaram p <0,2 foram incluídas no ajuste multivariado por meio de regressão logística. Resultados A amostra foi composta apenas por homens, a maioria de pele branca (55,6 versus 57,9% para homicidas e não-homicidas, respectivamente) e com alta prevalência de reprovações escolares (77,8 vs. 91,2%). Houve alta prevalência de antecedentes familiares de delinquência (88 versus 81%). Apenas anos de estudo e pertencimento ou não a uma organização criminosa permaneceram estatisticamente significantes no modelo multivariado. Conclusão Os resultados mostram que ter menos anos de estudo e negar pertencer a uma organização criminosa foram fatores preditivos de comportamento homicida em adolescentes infratores (ambos com relevância estatística). As demais variáveis não foram estatisticamente significativas para esse desfecho. O presente estudo pode servir como base para futuras pesquisas, o que pode melhorar nossa compreensão dos fatores de risco para o homicídio juvenil.

Youth homicide: a study of homicide predictor factors in adolescent offenders in custody in the south of Brazil.

OBJECTIVES: To assess the sociodemographic, psychiatric and criminal profile of adolescent offenders complying with temporary custody for homicide/homicide attempt and to compare it to that of the population of adolescents in custody for other crimes. METHODS: This cross-sectional study was based on the review of the medical records of 74 juvenile offenders in temporary custody at socioeducational agency Fundação de Atendimento Sócio-Educativo do Rio Grande do Sul. For the analysis, variables that presented p < 0.2 were included in multivariate adjustment through logistic regression. RESULTS: The sample comprised males only, mostly with white skin color (55.6 vs. 57.9% for homicidal and non-homicidal, respectively) and with a high prevalence of school failure (77.8 vs. 91.2%). There was a high prevalence of family history of delinquency (88 vs. 81%). Only years of study and belonging or not to a criminal organization remained statistically significant in the multivariate model. CONCLUSION: The results show that having fewer years of study and denying belonging to a criminal organization are predictive factors of homicidal behavior in adolescent offenders (both with statistical relevance). The other variables were not statistically significant for this outcome. The present study may serve as a basis for further research, which may improve our understanding of risk factors for juvenile homicide.

WAGRO syndrome: a rare genetic condition associated with aniridia and additional ophthalmologic abnormalities / Síndrome WAGRO: uma condição genética rara associada à aniridia e a anormalidades oftalmológicas adicionais

ABSTRACT Aniridia is a congenital eye disorder with a variable degree of hypoplasia or absence of iris tissue. It is caused by loss of function of the PAX6 gene and may be an isolated ocular abnormality or part of a syndrome. WAGRO refers to a rare genetic condition leading to Wilms tumor, aniridia, genitourinary anomalies, mental retardation, and obesity and is caused by a deletion of the short arm of chromosome 11 (11p), where the PAX6 gene is located. Here, we report on an 8-year-old boy with aniridia, polar cataract, and lens subluxation along with neuropsychomotor and speech delays. Karyotype evaluation showed an interstitial deletion including region 11p13-p14, confirming the diagnosis of WAGRO syndrome. In cases of aniridia, a diagnosis of WAGRO syndrome should be considered.

RESUMO A aniridia é uma doença ocular congênita com grau variável de hipoplasia ou ausência do tecido da íris. É causada pela perda de função do gene PAX6 e pode ser uma anormalidade ocular isolada ou parte de uma síndrome. WAGRO refere-se a uma condição genética rara que leva ao tumor de Wilms, aniridia, anomalias geniturinárias, déficit intelectual e obesidade e é causada por uma deleção do braço curto do cromossomo 11 (11p), onde o gene PAX6 está localizado. Aqui, nós relatamos um menino de 8 anos de idade com aniridia, catarata polar e subluxação do cristalino, além de retardo neuropsicomotor e de fala. A avaliação cariotípica revelou uma deleção intersticial envolvendo a região 11p13-p14, confirmando o diagnóstico da síndrome WAGRO. Em casos de aniridia, um diagnóstico de síndrome de WAGRO deve ser considerado.

WAGRO syndrome: a rare genetic condition associated with aniridia and additional ophthalmologic abnormalities.

Aniridia is a congenital eye disorder with a variable degree of hypoplasia or absence of iris tissue. It is caused by loss of function of the PAX6 gene and may be an isolated ocular abnormality or part of a syndrome. WAGRO refers to a rare genetic condition leading to Wilms tumor, aniridia, genitourinary anomalies, mental retardation, and obesity and is caused by a deletion of the short arm of chromosome 11 (11p), where the PAX6 gene is located. Here, we report on an 8-year-old boy with aniridia, polar cataract, and lens subluxation along with neuropsychomotor and speech delays. Karyotype evaluation showed an interstitial deletion including region 11p13-p14, confirming the diagnosis of WAGRO syndrome. In cases of aniridia, a diagnosis of WAGRO syndrome should be considered.

Attempted Serial Neonaticides: Case Report and a Brief Review of the Literature.

Neonaticide is an infant murder occurring on the day of birth. The case reports found in the literature are often focused on the mother as the agent in the context of pregnancy denial, dissociative symptoms, or psychosis. However, this report describes a rare case of attempted serial neonaticides, in which the acts were committed by a nurse at the nursery of a referral hospital in Brazil. The authors describe a forensic psychiatric evaluation for criminal responsibility and correlate the information from this particular case with relevant forensic themes, namely neonaticide, Munchausen by proxy syndrome, and serial healthcare killers.