Análisis descriptivo de la simulación de síntomas psicológicos en una muestra forense / Descriptive analysis of malingered psychological symptoms in a forensic sample

INTRODUCCIÓN: La simulación, definida como intento deliberado de mentir o engañar en relación con una enfermedad o discapacidad, exagerando la sintomatología, con el objetivo de obtener un beneficio personal, es un fenómeno complejo, poco estudiado en nuestro contexto profesional. El objetivo de este estudio fue analizar el modo en que se manifiesta dicho fenómeno en el ámbito forense. MATERIAL Y MÉTODOS: Se seleccionó una muestra incidental de 190 sujetos atendidos en la Unidad de Psicología (IMLCFC) durante 16 meses. Se les administró el Inventario estructurado de simulación de síntomas, a la vez que se valoraban ciertos indicadores clínicos de simulación y otros resultados psicométricos. Se realizó un análisis estadístico descriptivo de la muestra, así como de las correlaciones entre sospecha clínica y psicométrica, y entre sensibilidad del instrumento específico y de los instrumentos genéricos. RESULTADOS: El criterio clínico estructurado para detectar la simulación correlaciona moderadamente con el resultado obtenido en el Inventario estructurado de simulación de síntomas; la puntuación total en esta prueba presenta una correlación positiva, aunque atenuada, con los indicadores de exageración del principal test de psicopatología; la simulación es un estilo de respuesta altamente prevalente en sujetos de la jurisdicción social, con un patrón de respuestas significativamente incrementado respecto al observado en muestras penales. DISCUSIÓN: La valoración de la simulación de síntomas psicológicos en el contexto forense requiere de una estrategia multimétodo que incluya el juicio clínico estructurado, instrumentos específicos de detección y otras pruebas psicométricas complementarias, al efecto de generar validez convergente que contribuya a la detección de dicho fenómeno

INTRODUCTION: Malingering, defined as a deliberate attempt to lie or deceive in connection with an illness or disability, exaggerating the symptomatology, with the aim of obtaining a personal benefit, is a complex phenomenon, seldom studied in our professional context. The objective of this study was to analyse the way in which this phenomenon manifests itself in the forensic field. MATERIAL AND METHODS: An incidental sample of 190 subjects attended in the Psychology Unit (IMLCFC) over 16 months was selected. The Structured Inventory of Malingered Symptomatology (SIMS) was administered to them, while assessing certain clinical indicators of malingering and other psychometric results. A descriptive statistical analysis of the sample was performed, focusing on the correlations between clinical and psychometric suspicion, and on specific vs. generic test sensitivity. RESULTS: The structured clinical criterion to detect malingering correlates moderately with the result obtained in the SIMS; the total score in this test presents a positive, albeit attenuated, correlation with the exaggeration indicators from the main psychopathology test; malingering is a highly prevalent response style in subjects seeking work-related sickness compensation, with a pattern of significantly increased responses compared to that observed in criminal samples. DISCUSSION: The assessment of malingered psychological symptoms in the forensic context requires a multi-method strategy that includes structured clinical diagnosis, specific detection instruments, and other complementary psychometric tests, in order to generate convergent validity that contributes to the detection of this phenomenon

Short-term clinical risk assessment and management: Comparing the Brockville Risk Checklist and Hamilton Anatomy of Risk Management.

The current article aims to examine the performance of two brief, dynamic risk measures - the Brockville Risk Checklist (BRC4) and one of two versions of the Hamilton Anatomy of Risk Management [HARM-FV and electronic HARM-FV (eHARM-FV)] - scored at regular clinical case conferences for forensic psychiatric patients in two different settings. The eHARM represents a first-in-class dynamic risk assessment tool using data analytics. Two studies are presented from two forensic psychiatric hospitals in Ontario, Canada. The first study compared the HARM-FV, scored by trained research staff, with the BRC4, scored concurrently by clinical teams, on 36 forensic inpatients. In the second study, trained research staff scored both the BRC4 and the eHARM-FV on 55 forensic inpatients. Both studies demonstrated that the BRC4 and both HARM-FV tools were moderately and positively correlated with each other, with higher agreement for similar domains and items. In both samples, the risk measures performed better at identifying individuals who engaged in repeated or more serious problematic behavior. The HARM-FV and eHARM-FV produced higher area under the curve values for subsequent behavior compared with the BRC4. All three tools were effective at detecting future aggression and adverse incidents. We did not directly compare the HARM-FV and eHARM-FV.

Applicability of two violence risk assessment tools in a psychiatric prison hospital population.

The risk of violent behavior is known to be higher for patients who suffer from a severe mental disorder. However, specific prediction tools for clinical work in prison psychiatry are lacking. In this single-center study, two violence risk assessment tools (Forensic Psychiatry and Violence Tool, "FoVOx," and Mental Illness and Violence Tool, "OxMIV") were applied to a prison hospital population with a primary psychotic or bipolar disorder and subsequently compared. The required information on all items of both tools was obtained retrospectively for a total of 339 patients by evaluation of available patient files. We obtained the median and inter-quartile range for both FoVOx and OxMIV, and their rank correlation coefficient along with 95% confidence intervals (CIs)-for the full cohort, as well as for cohort subgroups. The two risk assessment tools were strongly positively correlated (Spearman correlation = 0.83; 95% CI = 0.80-0.86). Such a high correlation was independent of nationality, country of origin, type of detention, schizophrenia-spectrum disorder, previous violent crime and alcohol use disorder, where correlations were above 0.8. A lower correlation was seen with patients who were 30 years old or more, married, with affective disorder and with self-harm behavior, and also in patients without aggressive behavior and without drug use disorder. Both risk assessment tools are applicable as an adjunct to clinical decision making in prison psychiatry.

The use of test instruments in forensic report writing - Explorative research in Flanders.

BACKGROUND: Forensic psychiatric reports have a profound impact on the life of a defendant, on society and on the mental health system. Good-quality reports are essential but are often criticized for their lack of thorough substantiation. The use of multiple methods to obtain information, test instruments (psychological and/or risk) and third-party information are recommended. STUDY PURPOSE: To explore the use of test instruments and third-party information, as part of a multi-method approach, in forensic psychiatric evaluations. We examined 151 court-ordered expert reports in Flanders (Belgium). RESULTS: A psychological test instrument was used in 61% of the cases, and a risk taxation instrument in 19% of the cases. Third-party information was used in 43% of the cases. CONCLUSIONS: A multi-method approach is not common practice in forensic psychiatric evaluations. The use of validated test instruments and third-party information can be improved. The quality of forensic reports could be improved by the establishment of a forensic observation centre and the use of a standardized approach.

The factors associated with forensic psychiatrists' decisions in criminal responsibility and social dangerousness evaluations.

Despite the central role in criminal trials, there is little research on the decision-making processes of experts in forensic psychiatry. We aimed to investigate the role of sociodemographic, psychopathological, and criminological characteristics in forensic psychiatric decisions on criminal responsibility and social dangerousness in criminal trials. We analyzed 302 forensic psychiatric reports provided by 16 forensic psychiatrists from the North, Central and Southern Italy. Defendants' psychiatric symptom severity was evaluated through the 24-item Brief Psychiatric Rating Scale (BPRS), the Clinical Global Impression (CGI) scale and the Global Assessment of Functioning (GAF). Defendants judged not criminally responsible (Not-CRDs) presented with more severe psychiatric symptoms (positive symptoms, negative symptoms, manic excitement / disorganization), were more likely to be female, to be affected by a schizophrenia spectrum disorder, or bipolar spectrum disorder and to have had a higher number of previous psychiatric treatments and previous involuntary hospitalizations compared to their criminally responsible counterparts. Not-CRDs affected by a schizophrenia spectrum disorder, personality disorder, with severe psychiatric symptoms and with histories of criminal convictions and more victims were more likely to have received a judgment of social dangerousness. The forensic psychiatric evaluations were carried out on average of 770 days after the time of the crime, which in light of the other results, suggests an effect of the perceptions of the expert on the judgment of responsibility, raising the possibility of time bias on forensic judgments concerning defendants' mental responsibility.

Neuroscience and mental state issues in forensic assessment.

Neuroscience has already changed how the law understands an individual's cognitive processes, how those processes shape behavior, and how bio-psychosocial history and neurodevelopmental approaches provide information, which is critical to understanding mental states underlying behavior, including criminal behavior. In this paper, we briefly review the state of forensic assessment of mental conditions in the relative culpability of criminal defendants, focused primarily on the weaknesses of current approaches. We then turn to focus on neuroscience approaches and how they have the potential to improve assessment, but with significant risks and limitations.

Assessing Risk for Victimization in a Forensic Psychiatric Setting Using the Short-Term Assessment of Risk and Treatability.

Although a growing literature on community-based victimization of people with mental illness exists, victimization within institutional settings is comparatively understudied. The current study seeks to fill this gap by exploring factors related to risk of victimization in a male forensic psychiatric sample using a relatively new risk assessment measure. The Short-Term Assessment of Risk and Treatability (START) is a short-term risk assessment measure that compiles information about several clinically relevant risk factors to evaluate risk of victimization, among other adverse outcomes. Nearly one-third (31.3%) of the sample experienced some type of victimization during their hospitalization. The summary risk judgment and subsets of select START items effectively predicted risk of victimization in this sample with a fair degree of accuracy over a 2-month period.

El test del reloj en la evaluación forense / Clock drawing test in forensic assessment

Introducción: El test del reloj es una prueba de cribado neuropsicológico que se utiliza con frecuencia en la práctica clínica. Objetivo: Valorar la utilidad del test del reloj en el ámbito forense. Evaluar 3métodos de corrección, explorar la fiabilidad y validez, y valorar su utilidad en procesos judiciales de modificación de la capacidad de obrar. Material y métodos: Se analizaron 40 casos incursos en procedimientos judiciales. Se realizó una entrevista clínica estructurada, exploración neurológica y psicopatológica a través de la prueba CAMDEX-R. Se administró el Mini-Mental State Examination, la Global Deterioration Scale y el test del reloj a la orden corregido con los métodos de CAMCOG, Manos y Méndez. La muestra se dividió en 3grupos: degenerativo, psiquiátrico y sin trastorno. Resultados: El grupo degenerativo es el que obtuvo peores resultados en el test del reloj en los 3métodos de corrección. La fiabilidad y validez de la prueba resultaron adecuadas. Los pacientes incapacitados judicialmente presentaron peor rendimiento en el test del reloj. Conclusiones: Los 3métodos de corrección del test del reloj se muestran eficaces. Valorando el coste-beneficio, se recomienda el método más breve. Los pacientes con una sentencia de modificación de la capacidad civil presentan peores resultados en el test del reloj

Introduction: The clock drawing test is a neuropsychological screening test that is frequently used in clinical practice. Aim: To evaluate the usefulness of the clock drawing test in the forensic environment. To evaluate 3methods of correction, and to determine its reliability and validity, and assess its usefulness in judicial processes of modification of legal capacity of a person. Material and methods: A total of 40 cases were analysed in legal proceedings. A structured clinical interview, and a neurological and psychopathological examination were conducted using the CAMDEX-R test. The Mini-Mental State Examination, the Global Deterioration Scale, and the clock drawing test were administered to the order corrected using the CAMCOG, Manos and Méndez methods. The sample was divided into 3groups: degenerative, psychiatric, and without pathology. Results: The degenerative group obtained the worst results in the clock drawing test in the 3correction methods. The reliability and validity of the test were adequate. Patients judged not to be legally capable had a worse performance in the clock drawing test. Conclusions: The 3methods of correction of the clock drawing test are shown to be effective. Evaluating the cost-benefit of the short method is recommended. Patients with a modification of legal capacity ruling showed worse results in the clock drawing test

Risk prediction using natural language processing of electronic mental health records in an inpatient forensic psychiatry setting.

OBJECTIVE: Instruments rating risk of harm to self and others are widely used in inpatient forensic psychiatry settings. A potential alternate or supplementary means of risk prediction is from the automated analysis of case notes in Electronic Health Records (EHRs) using Natural Language Processing (NLP). This exploratory study rated presence or absence and frequency of words in a forensic EHR dataset, comparing four reference dictionaries. Seven machine learning algorithms and different time periods of EHR analysis were used to probe which dictionary and which time period were most predictive of risk assessment scores on validated instruments. MATERIALS AND METHODS: The EHR dataset comprised de-identified forensic inpatient notes from the Wilfred Lopes Centre in Tasmania. The data comprised unstructured free-text case note entries and serial ratings of three risk assessment scales: Historical Clinical Risk Management-20 (HCR-20), Short-Term Assessment of Risk and Treatability (START) and Dynamic Appraisal of Situational Aggression (DASA). Four NLP dictionary word lists were selected: 6865 mental health symptom words from the Unified Medical Language System (UMLS), 455 DSM-IV diagnoses from UMLS repository, 6790 English positive and negative sentiment words, and 1837 high frequency words from the Corpus of Contemporary American English (COCA). Seven machine learning methods Bagging, J48, Jrip, Logistic Model Trees (LMT), Logistic Regression, Linear Regression and Support Vector Machine (SVM) were used to identify the combination of dictionaries and algorithms that best predicted risk assessment scores. RESULTS: The most accurate prediction was attained on the DASA dataset using the sentiment dictionary and the LMT and SVM algorithms. CONCLUSIONS: NLP, used in conjunction with NLP dictionaries and machine learning, predicted risk ratings on the HCR-20, START, and DASA, based on EHR content. Further research is required to ascertain the utility of NLP approaches in predicting endpoints of actual self-harm, harm to others or victimisation.

La intención es lo que cuenta. Una revisión sobre la detección del engaño en intenciones / It's the intention that counts. A review on deception detection focused on intentions

Durante años la investigación sobre detección del engaño ha estado guiada por las teorías clásicas que sustentaban la idea de que el mentiroso emitía indicadores conductuales que lo delataban. Dentro de las nuevas líneas de investigación, ha surgido la detección del engaño focalizado en intenciones. Haremos un repaso de los estudios sobre la detección del engaño focalizados en intenciones futuras. Explicaremos brevemente el pensamiento episódico futuro (EFT), a continuación las primeras aproximaciones en este campo a través de la comparativa entre el engaño sobre hechos pasados vs futuros. Veremos además aquellos estudios que utilizan las preguntas inesperadas en un dominio no anticipado (fase de planificación de un viaje, calidad de esa planificación y sobre el pensamiento episódico futuro), y finalizaremos por los que manejan la evidencia de manera estratégica

For years the research on deception detection has been guided by classical theories that support the idea that the liar gives out behavioral indicators which betray him/her. Within the new lines of research, deception detection focused on intentions has emerged. In this paper we review the studies on deception detection focused on intentions. We briefly explain episodic future thought (EFT) and the first approaches in this field through the comparison of deception detection in past and future events. Additionally, we take a look at the studies that use unexpected questions in a non-anticipated domain (trip planning phase, quality of the planning, and EFT), and we finish by discussing the ones that use evidence strategically

Risk Assessment in Habitual Offenders With Substance Use Problems: A Quasi-Prospective Study of the Predictive Validity of the HKT-30.

The predictive validity of the Dutch risk assessment instrument HKT-30 was investigated with a quasi-prospective design in a sample of habitual offenders with a substance use disorder (SUD). The study is reported according to RAGEE guidelines. The HKT-30 is an extension of the HCR-20. Files of 89 patients were coded and recidivism data were requested from the Ministry of Justice. Total scale scores and scores of the Clinical and Future scales were significantly predictive of recidivism for 1 and 2 years of time at risk, respectively. In contrast to earlier studies into recidivism, the H-scale had no predictive value. Regression analysis showed that the Clinical and Future scales contributed to the explanation of variance in recidivism, but not independently from each other. The conclusion is that the HKT-30 is a useful instrument for discovering risk factors and predicting recidivism for the population of habitual offenders with an SUD.

Validating the Hamilton Anatomy of Risk Management-Forensic Version and the Aggressive Incidents Scale.

The Hamilton Anatomy of Risk Management-Forensic Version (HARM-FV) is a structured professional judgement tool of violence risk developed for use in forensic inpatient psychiatric settings. The HARM-FV is used with the Aggressive Incidents Scale (AIS), which provides a standardized method of recording aggressive incidents. We report the findings of the concurrent validity of the HARM-FV and the AIS with widely used measures of violence risk and aggressive acts, the Historical, Clinical, Risk Management-20, Version 3 (HCR-20V3) and a modified version of the Overt Aggression Scale. We also present findings on the predictive validity of the HARM-FV in the short term (1-month follow-up periods) for varying severities of aggressive acts. The results indicated strong support for the concurrent validity of the HARM-FV and AIS and promising support for the predictive accuracy of the tool for inpatient aggression. This article provides support for the continued clinical use of the HARM-FV within an inpatient forensic setting and highlights areas for further research.

The Reliability and Predictive Validity of the Stalking Risk Profile.

This study assessed the reliability and validity of the Stalking Risk Profile (SRP), a structured measure for assessing stalking risks. The SRP was administered at the point of assessment or retrospectively from file review for 241 adult stalkers (91% male) referred to a community-based forensic mental health service. Interrater reliability was high for stalker type, and moderate-to-substantial for risk judgments and domain scores. Evidence for predictive validity and discrimination between stalking recidivists and nonrecidivists for risk judgments depended on follow-up duration. Discrimination was moderate (area under the curve = 0.66-0.68) and positive and negative predictive values good over the full follow-up period ( Mdn = 170.43 weeks). At 6 months, discrimination was better than chance only for judgments related to stalking of new victims (area under the curve = 0.75); however, high-risk stalkers still reoffended against their original victim(s) 2 to 4 times as often as low-risk stalkers. Implications for the clinical utility and refinement of the SRP are discussed.

Compulsory psychiatric treatment checklist: Instrument development and clinical application.

Instruments designed to evaluate the necessity of compulsory psychiatric treatment (CPT) are scarce to non-existent. We developed a 25-item Checklist (scoring 0 to 50) with four clusters (Legal, Danger, Historic and Cognitive), based on variables identified as relevant to compulsory treatment. The Compulsory Treatment Checklist (CTC) was filled with information on case (n=324) and control (n=251) subjects, evaluated under the Portuguese Mental Health Act (Law 36/98), in three hospitals. For internal validation, we used Confirmatory Factor Analysis (CFA), testing unidimensional and bifactor models. Multilevel logistic regression model (MLL) was used to predict the odds ratio (OR) for compulsory treatment based on the total scale score. Receiver Operating Characteristic analysis (ROC) was performed to predict compulsory treatment. CFA revealed the best fit indexes for the bifactor model, with all items loading on one General factor and the residual loading in the a priori predicted four specific factors. Reliability indexes were high for the General factor (88.4%), and low for specific factors (<5%), which demonstrate that CTC should not be performed in the subscales to access compulsory treatment. MLL reveals that for each item scored in the scale, it increases the OR by 1.26 for compulsory treatment (95%CI 1.21-1.31, p<0.001). Based on the total score, accuracy was 90%, and the best cut-off point of 23.5 detects compulsory treatment with a sensitivity of 75% and specificity of 93.6%. The CTC presents robust internal structure with a strong unidimensional characteristic, and a cut-off point for compulsory treatment of 23.5. The improved 20-item version of the CTC could represent an important instrument to improve clinical decision regarding CPT, and ultimately to improve mental health care of patients with severe psychiatric disorders.

Initial development of the Psychopathic Processing and Personality Assessment (PAPA) across populations.

Three studies describe development of the Psychopathic Processing and Personality Assessment (PAPA). Study one outlines a literature review and Expert Delphi (n=32) to develop the initial PAPA. Study two validates the PAPA with 431 participants (121 male prisoners and 310 university students: 154 men, 156 women), also using the Levenson Self Report Psychopathy scale and a measure of cognitive schema and affect. Study three refined the PAPA, employing it with 50 male students and 40 male forensic psychiatric patients using clinical (interview) assessments of psychopathy: the Psychopathy Checklist - Screening Version and the Affect, Cognitive and Lifestyle assessment. The PAPA comprised four factors; dissocial tendencies; emotional detachment; disregard for others; and lack of sensitivity to emotion. It positively correlated with existing psychopathy measures. Variations across PAPA subscales were noted across samples when associated with clinical measures of psychopathy. Support for the validity of the PAPA was indicated across samples. Directions for research and application are outlined.

Contrasting the efficacy of the MMPI-2-RF overreporting scales in the detection of malingering / Contraste de la eficacia de las escalas de validez del MMPI-2-RF en la detección de la simulación

Though it has been the most extensively used instrument for forensic evaluation, the MMPI-2 is being gradually replaced by the MMPI-2-RF version, requiring evidence research to support it. A malingering design was implemented to assess the efficacy of the overreporting validity scales in discriminating between a group of malingerers and the general and clinical populations in a forensic context. Of a total of 878 subjects, 309 were from the general population, 308 from the clinical population, and 261 were instructed to malinger a psychological injury. The results showed that malingerers scored significantly higher than the clinical and general population on the F-r, Fp-r, FBS-r, Fs and RBS scales. As for the classification of cases, the F-r, Fp-r, FBS-r, Fs, and RBS scales classified correctly and significantly between malingerers and honest respondents from the general population, and the F-r and Fp-r scales between malingerers and clinical population. Additionally, the results showed F-r incremental validity over Fp-r, and vice versa. Thus, F-r and Fp-r scales are independent and may be accumulated to detect malingering. Forensic practical implications from the results were derived and discussed (AU)

Aunque el MMPI-2 ha sido el instrumento psicométrico más usado en la evaluación forense, está siendo reemplazado gradualmente por la versión reestructurada, el MMPI-2-RF precisándose de más evidencia científica para ello. Se utilizó un dise˜no de investigación de simulación para evaluar la eficacia de las escalas de validez de evaluación de la simulación en la discriminación entre simuladores y las poblaciones general y clínica en el contexto forense. Participaron en el estudio 878 sujetos, 309 de la población general, 308 casos clínicos y 261 instruidos para simular da˜no psicológico. Los resultados mostraron que los simuladores puntuaban significativamente más alto que los sujetos de las poblaciones general y clínica en las escalas F-r, Fp-r, FBS-r, Fs y RBS. En la clasificación de casos, las escalas F-r, Fp-r, FBS-r, Fs y RBS clasificaban correcta y significativamente entre simuladores y respuestas honestas de la población general, y las escalas F-r and Fp-r entre simuladores y población clínica. Además, los resultados evidenciaron validez incrementada de F-r sobre Fp-r y viceversa. Se discuten las implicaciones para la práctica forense de los resultados (AU)

Validation of the "Security Needs Assessment Profile" for measuring the profiles of security needs of Chinese forensic psychiatric inpatients.

Mapping forensic psychiatric services with the security needs of patients is a salient step in service planning, audit and review. A valid and reliable instrument for measuring the security needs of Chinese forensic psychiatric inpatients was not yet available. This study aimed to develop and validate the Chinese version of the Security Needs Assessment Profile for measuring the profiles of security needs of Chinese forensic psychiatric inpatients. The Security Needs Assessment Profile by Davis was translated into Chinese. Its face validity, content validity, construct validity and internal consistency reliability were assessed by measuring the security needs of 98 Chinese forensic psychiatric inpatients. Principal factor analysis for construct validity provided a six-factor security needs model explaining 68.7% of the variance. Based on the Cronbach's alpha coefficient, the internal consistency reliability was rated as acceptable for procedural security (0.73), and fair for both physical security (0.62) and relational security (0.58). A significant sex difference (p=0.002) in total security score was found. The Chinese version of the Security Needs Assessment Profile is a valid and reliable instrument for assessing the security needs of Chinese forensic psychiatric inpatients.

Convergent and Predictive Validity of the Jesness Inventory in a Sample of Juvenile Offenders.

The present study examined the convergent and predictive validity of the Jesness Inventories (JI) in a sample of 138 juvenile offenders, completed in the course of routine service delivery. JI profiles were compared with ratings on three standardized forensic clinical scales: the Youth Level of Service/Case Management Inventory, Psychopathy Checklist: Youth Version, and Violence Risk Scale-Youth Version. The JI Asocial Index and the Undersocialized Active and Group-Oriented Conformist Interpersonal Maturity Level (I-level) subtypes demonstrated the strongest pattern of convergence and most consistently predicted recidivism. The Asocial Index did not incrementally predict recidivism after controlling for scores on the standardized forensic clinical scales; however, meaningful differences among broad I-Level groups (I-3 and I-4) remained after controlling for risk. Risk-need-responsivity applications of the JI (i.e., in terms of treatment dosage, identifying treatment targets, and adaptation of services) are discussed within the context of a comprehensive forensic assessment framework to inform case formulation, service delivery, and decision making with justice involved youth.

'Más piedad que improperios': un informe pericial del Dr. Egas Moniz sobre homosexualidad / 'More piety than profanities': an expert report by Dr. Egas Moniz on homosexuality

A principios del siglo XX, Egas Moniz, insigne neurólogo y Premio Nobel portugués, emitió un informe pericial sobre homosexualidad para un caso de anulación matrimonial que constituye un material de gran valor como ejemplo de aplicación efectiva del conocimiento sexológico disponible en la época. En este mismo periodo la flamante legislación republicana estableció la anulación del matrimonio contemplando causas de carácter médico y se tipificaron penalmente las relaciones entre personas del mismo sexo, o contra natura. En su informe, Egas Moniz interpretó desde las categorías sexológicas de la época distintos elementos de la vida del sujeto estudiado, ilustrando la interacción entre estas categorías y las formas cambiantes que adoptó la homosexualidad (o las personas homosexuales) de la época (AU)

At the beginning of the 20th century, the noted Nobel prize-winning Portuguese neurologist Egas Moniz made an expert analysis on homosexuality in a marriage annulment case of major value as an example of the effective application of sexological knowledge of that period. Contemporary republican legislation established marriage annulment in medical terms and punished relations between persons of the same sex, or contra natura. In his report, Moniz attempted to interpret distinctive elements of the life of the subject using sexological categories, illustrating the interaction between these categories and the changing forms adopted by homosexuality (or homosexual people) of the time (AU)

Repercusiones funcionales y legales de un trastorno orgánico de la personalidad tras un infarto cerebral / Functional and legal repercussions of an Organic personality disorder following a stroke

El trastorno orgánico de la personalidad supone una alteración significativa de las formas habituales del comportamiento premórbido, afectando particularmente a la expresión de las emociones, necesidades e impulsos. Se presenta el caso de una mujer de 49 años de edad que, tras padecer un infarto cerebral, presentó una transformación de su personalidad y de sus valores previos. Anteriormente era una persona con múltiples miedos, cuidadosa, metódica en su vida diaria. Tras el infarto comenzó a presentar conductas de provocación y una mayor desinhibición e impulsividad, menor tolerancia a la frustración, así como mínima capacidad de planificación y resolución de problemas. Además, fue incapaz de conservar ningún trabajo y perdió las relaciones sociales. Se realizaron estudios de imagen (tomografía computarizada (TC) y resonancia magnética (RM)), electroencefalograma (EEG) y una evaluación neuropsicológica. Los resultados obtenidos son compatibles con un trastorno orgánico de la personalidad subtipo desinhibido, caracterizado clínicamente por la tendencia a la labilidad emocional, la desinhibición conductual y la falta de control de impulsos. El trastorno orgánico de la personalidad es una afectación crónica e irreversible que está influyendo en la capacidad de autogobierno de la paciente, y por ello deben valorarse los aspectos psiquiátrico-forenses pertinentes (AU)

The organic personality disorder causes a significant alteration of the habitual patterns of behavior displayed by the subject premorbidly, involving the expression of emotions, needs and impulses. We report the case of a 49-year-old woman who, after suffering a cerebral infarction, presented a transformation of her personality traits and previous values. She was previously a person with multiple fears, careful, methodical in her daily life. After the cerebral infarction she began to present conducts of provocation and major disinhibition, impulsiveness, minor tolerance to the frustration, minimal capacity of planning and resolution of problems. In addition, she was unable to preserve any work and lost the social relationships. Neuroimaging studies (CT, MR), EEG and a neuropsychological assessment were conducted. The obtained results are compatible with an Organic Personality Disorder disinhibited subtype, clinically characterized by emotional liability, disinhibited behavior and lack of impulses control. The organic personality disorder is a chronic irreversible disease that is affecting the self-government patient´s ability and therefore relevant forensic psychiatric aspects must be assessed (AU)