Elusive cases in forensic psychiatry? Exploring subgroups of schizophrenia spectrum disorder patients in Germany.

BACKGROUND: The relationship between schizophrenia spectrum disorders (SSD) and criminal behaviour is a central issue in forensic psychiatry. People with mental illness face some of the same types of criminogenic factors as people without mental illness, albeit more frequently. The research question of this study is the extent to which a framework of early and late offender typology can be empirically reconstructed in a forensic psychiatric population, and whether there are any practical implications. METHOD: For N = 733 patients in six different forensic hospitals in Germany, the age at first psychiatric admission and the age at first registered offence were documented, as well as a number of other patient-related characteristics. Two clustering procedures were used to investigate whether forensic psychiatric patients could be classified according to these characteristics. RESULTS: A k-means cluster analysis using age at first psychiatric admission, age at first recorded offence, sociodemographic, clinical and criminological characteristics supported a 4-cluster solution. MANOVA analyses revealed further differences between the identified types. CONCLUSION: This study empirically confirms some of the sub-groups of the early and late starter typology described in the literature. In particular, the "early starters", "late starters" and "first presenters" were identified, but cluster four comprises individuals not previously described in the scientific literature. Each of these classes has group-specific characteristics that may have implications for forensic treatment, post-release aftercare, and the legal system.

Experts' decision-making processes in Swedish forensic psychiatric investigations: A case vignette study.

It has previously been demonstrated that decisions made by forensic experts can suffer from issues with both bias and poor reliability. The outcome of Swedish forensic psychiatric investigations can have a major impact on the courts' choice of sanction for a mentally disordered offender. These investigations are performed by multi-professional teams of experts, where each expert is obliged to state their opinion on whether the client has a severe mental disorder (SMD) or not. In the present study, a case vignette design was used to simulate the decision-making process of forensic psychiatric investigations. Of the 73 Swedish experts working with forensic psychiatric investigations, a total of 27 (37%) participated in the study. The results showed that the Swedish experts formulated multiple diagnostic hypotheses about cases throughout the process and revised these hypotheses when presented with new information. There was substantial variation between the experts in which hypotheses were seen as most relevant. While the experts grew more certain of their opinions on SMD during the simulated investigation, there was considerable variation in their opinions both throughout and at the end of the process. Although low statistical power and the sample not being randomized limit generalizations, the results indicate no idiosyncratic patterns in the decision-making processes of Swedish experts or signs of confirmation bias. If used properly, the variation in both process and outcome could be used to safeguard and possibly increase the reliability and validity of the final decision of Swedish forensic psychiatric investigations.

What happens after forensic psychiatric care? A latent class analysis of dimensions of welfare for former forensic psychiatric patients.

BACKGROUND: Mentally disordered offenders are a heterogenous group regarding psychopathology as well as background factors, which makes it likely that more than one stereotypical life situation will apply to all forensic psychiatric patients following discharge. Knowledge about typical life situations would be valuable for optimising support for improving the overall life situation of these individuals. This paper investigates life situations from the perspective of level of living research and resources in terms of different welfare dimensions. METHODS: Included were all all individuals (n = 1146) who had been discharged from forensic psychiatric care in Sweden during 2009-2018 and were included in the Swedish National Forensic Psychiatric Register. Follow-up time varied from 4 to 3644 days, (m = 1697, Md = 1685). Register data from several different registers was combined. Data was analysed using latent class analysis, and multinominal logistic regression analysis investigated what background factors were associated with class membership. RESULTS: The results show that there are four subgroups of post-discharge life situations: the high support group, the general psychiatric needs group, the working group, and the family group. The high support group was the largest, representing 54% of the entire sample. There are background factors associated with group membership, including both age at discharge, length of stay in forensic psychiatric care and pre-index crime historical factors. CONCLUSIONS: This study contributes to the understanding of the post-discharge lives of former forensic psychiatric patients and shows that for several subgroups, negative outcomes are rare. Knowledge about these subgroups could be drawn upon to make informed decisions about in- and outpatient forensic psychiatric care, discharge from forensic psychiatric services, and what support is offered to former forensic psychiatric patients.

Assessing Racial Effects on Adjudicative Competence.

As racial influences on forensic outcomes are identified in every aspect of practice, scholars are exploring methods to disentangle race from its historical, economic, and attitudinal antecedents. Because jurisdictions vary in these influences, definitions and data may differ among them, creating inconsistencies in analysis and policy. This retrospective database review compared differences in racial outcomes among 200 pretrial defendants, 160 Black and 40 White, exploring a wide range of socioeconomic, clinical, and forensic influences before, during, and after hospitalization. Because of the tight relationship of socioeconomic factors and race, investigators hypothesized that it would be difficult to distinguish racial influences alone. Using a confirmatory approach to data collection and a statistical analysis based in logistic regression, only differences in referral for psychological testing were identified. Application of this method based on local demographics and culture may prove useful for institutions interested in evaluating racial influences on forensic outcomes.

[Which Treatment Setting is Suited for Forensic Inpatients Aged≥60 Years?A Systemic Literature Analysis]. / Welches Behandlungssetting ist für stationäre forensische Patienten im Alter ≥ 60 Jahre geeignet?Eine systematische Analyse der Literatur.

In the inpatient correctional system, the question of a suitable treatment setting for older forensic inpatients (i. e. ≥60 years) arises against the background of demographic change. In this regard, the research literature was examined using four medical databases (PsycInfo, Medline, Embase, Web of Science) for relevant keywords (elderly offender/perpetrator, aged, mental disorder, forensic treatment, forensic psychiatry). Out of 744 pre-selected articles, only 5 studies made it into the final selection. The majority of the sample is composed of men with previous criminal justice experience, who may be mentally and/or physically ill. Placement and capacity problems as well as a lack of age-appropriate infrastructure are reported. Based on the study results, an empirical recommendation regarding a suitable treatment setting cannot be given.

Determinants of clinical outcome and length of stay in acute care forensic psychiatry units.

Criminological and sociodemographic variables, such as previous criminal convictions, increased risk of violence, early onset of mental disorder, antisocial personality, psychosis and low social support, have all been related to longer length of stay (LoS) and poorer outcome in long stay forensic services. The factors impacting on LoS and clinical response in acute care specialized units are poorly documented. To address this issue, we examined the psychiatric records of all cases admitted between January 1st and December 31th 2020 in the sole acute ward for detained persons located in the central prison of the Geneva County, Switzerland. Information on judicial status included pre-trial versus sentence execution, previous incarcerations, and age of the first incarceration. Sociodemographic data included age, gender, marital status, and education attainment. Previous inpatient stays prior to incarceration were recorded. All of the ICD-10 clinical diagnoses were made by two independent, board-certified psychiatrists blind to the scope of the study. The standardized assessment was based on the HoNOS (Health of Nation Outcome Scales) at admission and discharge, HONOS-secure at admission, HCR-20 (Historical Clinical Risk 20) version 2, PCL-R (Psychopathy Checklist Revised), and SAPROF (Structured Assessment of Protective Factors). Stepwise forward multiple linear regression models predicting the LoS and delta HONOS respectively were built with the above mentioned parameters. The selected variables were then used in univariate and multivariable regression models. Higher HCR-scores (mainly on clinical items), and longer LoS were related to higher delta HONOS scores. In contrast, cases in pre-trial detention showed a worst clinical outcome. In multivariable models, all three variables remained independent predictors of the clinical outcome and explained 30.7% of its variance. Only education and diagnosis of borderline personality were related to the LoS and explained 12.6% of its variance in multivariable models. Our results suggest that the use of acute wards specialized in forensic psychiatry are mainly useful for patients with prior inpatient care experience, and higher violence risk during sentence execution. In contrast, they seem to be less performant for persons in pre-trial detention that could benefit from less restrictive clinical settings.

Is mental health staff training in de-escalation techniques effective in reducing violent incidents in forensic psychiatric settings? - A systematic review of the literature.

BACKGROUND: Inpatient violence is a relevant issue in forensic psychiatric settings. Relevant guidelines recommend that restrictive measures are to be used exclusively if de-escalation and other preventive strategies have failed and there is a risk of harm to patients or staff if no action is taken. However, restrictive measures are untherapeutic and can be harmful. In order to enable staff to intervene before inpatient violence or other serious incidents occur and thus to avoid restrictive measures, mental health staff training programs including de-escalation components are being adopted in general as well as forensic mental health settings. There is growing evidence for the efficacy of mental health staff training in de-escalation techniques in the field of general psychiatry. However, there are no reviews evaluating the effectiveness of these interventions in reducing violent incidents in forensic psychiatric settings. Here we present the first literature review on the effectiveness staff training in de-escalation techniques in the field of forensic psychiatry. METHOD: We searched relevant databases for original research on the effectiveness of reducing violence in forensic psychiatric settings. Studies were included if they investigated staff training programs with de-escalation techniques in forensic mental health settings. RESULTS: A total of 5 relevant studies were identified. None of the studies was a randomized controlled trial. Four studies were before and after comparisons without control group. A one group post-test-only design was used in one study. Methodological quality was low. The maximum sample size was 112 participants. Results indicated no relevant impact of mental health staff training in de-escalation techniques on the rate of violent incidents in forensic psychiatric wards. However, staff seemed to feel safer following the training. Results have to be interpreted cautiously due to several methodological and content-related limitations. DISCUSSION: Evidence for the effectiveness of staff training in de-escalation techniques on reducing verbal and physical aggression in forensic settings remains very limited. The existing definitions of terms like de-escalation, de-escalation training and de-escalation techniques in the healthcare context appear rather vague. Although some positive changes are reported across a variety of outcome measures it remains unclear to what extent staff training in de-esclation techniques contributes to a reduction in aggressive incidents and restrictive measures in forensic psychiatry. The clinical implications of this review are therefore limited. Yet, an important implication for future research is that a more comprehensive approach might prove worthwhile. Conducting a further review integrating a wide range of complex interventions aimed at the reduction of inpatient violence rather than focusing on de-escalation only, might be a worthwhile approach.

Highly varying concepts and capacities of forensic mental health services across the European Union.

Introduction: There is wide variation in the processes, structures and treatment models for dealing with mentally disordered offenders across the European Union. There is a serious lack of data on population levels of need, national service capacities, or treatment outcome. This prevents us from comparing the different management and treatment approaches internationally and from identifying models of good practice and indeed what represents financial efficiency, in a sector that is universally needed. Methods: From March 2019 till January 2020 we surveyed forensic psychiatric experts from each European Union Member State on basic concepts, service capacities and indicators for the prevalence and incidence of various forensic psychiatric system components. Each expert completed a detailed questionnaire for their respective country using the best available data. Results: Finally, 22 EU Member States and Switzerland participated in the survey. Due to the frequent lack of a clear definition of what represented a forensic psychiatric bed, exact numbers on bed availability across specialized forensic hospitals or wards, general psychiatric hospitals or prison medical wards were often unknown or could only be estimated in a number of countries. Population-based rates calculated from the survey data suggested a highly variable pattern of forensic psychiatric provision across Europe, ranging from 0.9 forensic psychiatric beds per 100,000 population in Italy to 23.3 in Belgium. Other key service characteristics were similarly heterogeneous. Discussion: Our results show that systems for detaining and treating mentally disordered offenders are highly diverse across European Union Member States. Systems appear to have been designed and reformed with insufficient evidence. Service designers, managers and health care planners in this field lack the most basic of information to describe their systems and analyse their outcomes. As a basic, minimum standardized national reporting systems must be implemented to inform regular EU wide forensic psychiatry reports as a prerequisite to allow the evaluation and comparison of the various systems to identify models of best practice, effectiveness and efficiency.

Self-Harm Among Forensic Psychiatric Inpatients With Schizophrenia Spectrum Disorders: An Explorative Analysis.

The burden of self-injury among offenders undergoing inpatient treatment in forensic psychiatry is substantial. This exploratory study aims to add to the previously sparse literature on the correlates of self-injury in inpatient forensic patients with schizophrenia spectrum disorders (SSD). Employing a sample of 356 inpatients with SSD treated in a Swiss forensic psychiatry hospital, patient data on 512 potential predictor variables were retrospectively collected via file analysis. The dataset was examined using supervised machine learning to distinguish between patients who had engaged in self-injurious behavior during forensic hospitalization and those who had not. Based on a combination of ten variables, including psychiatric history, criminal history, psychopathology, and pharmacotherapy, the final machine learning model was able to discriminate between self-injury and no self-injury with a balanced accuracy of 68% and a predictive power of AUC = 71%. Results suggest that forensic psychiatric patients with SSD who self-injured were younger both at the time of onset and at the time of first entry into the federal criminal record. They exhibited more severe psychopathological symptoms at the time of admission, including higher levels of depression and anxiety and greater difficulty with abstract reasoning. Of all the predictors identified, symptoms of depression and anxiety may be the most promising treatment targets for the prevention of self-injury in inpatient forensic patients with SSD due to their modifiability and should be further substantiated in future studies.

Do we know the mind of others? Suspicion of malingering in emergency psychiatry.

INTRODUCTION: Malingering can be divided into simulation and exaggeration of symptoms. Malingering has traditionally been considered rare in general psychiatry. In contrast to earlier estimates, more recent studies report that doctors suspect malingering frequently in psychiatric emergency departments. The aim of this study is to survey how often doctors in psychiatric emergency units in a public, free-of-charge, mental health service suspect that patients are malingering, and which diagnoses, symptom complaints and suspected reasons for malingering doctors ascribe to their patients. METHODS: Questionnaires were distributed in three psychiatric emergency departments in Denmark. Suspected simulation and exaggeration were rated with a 5-point scale. Doctors were encouraged to write down the symptoms and perceived causes for suspected malingering. RESULTS: 362 questionnaires were filled in. 25% of all patients were suspected of simulating to some degree. 8% of patients were highly suspected or definitely believed to be simulating. Patients complaining of suicidal ideation were most frequently suspected of malingering. 'Attention seeking' was the most common suspected reason for malingering. Patients with diagnoses of substance use and personality disorder were the most suspected of malingering. CONCLUSION: This is the first study to investigate doctors' suspicions of psychiatric malingering in a European setting. Patients with established personality and substance use disorder are at higher risk of being suspected of malingering, which potentially affects the course of treatment significantly. The rise in suspected malingering is conspicuous and requires further investigation. Doctors are encouraged to act conservatively upon suspicion of malingering in emergency psychiatry.

Investigating the dynamic nature of multiple risk assessment instruments in a forensic mental health hospital.

Readministration of multiple risk assessment instruments to determine the risk of aggression over the short, medium, and long term is common practice in many forensic mental health settings. Justification for the repeated administration and use of multiple instruments is based on purported differences in discriminative validity of risk factors according to whether they are characterized as static, stable, or acute, and the composition of these tools, in terms of the relative balance of different types of risk factors, which can impact the discriminative validity of these instruments over different follow-up periods. However, research has yet to determine whether the use of multiple and repeated administration of risk assessment instruments improves identification of risk, and it may be the case that the heavy burden on service providers to administer multiple instruments is unwarranted. In this study, time-dependent cox regression with repeated assessments and recurrent events was used to investigate the dynamic nature and incremental validity of the dynamic appraisal of situational aggression (DASA), short-term assessment of risk and treatability (START), and HCR-20v3, which were repeatedly rated on a sample of forensic mental health inpatients (N = 240) over a 2-year period. Results suggest that using the rolling mean or the most recent risk assessment yielded the most accurate characterization of change in aggression risk. Repeated administration of dynamic risk instrument instruments improved the identification of aggression beyond the initial risk assessment. Although static, stable, and acute factors were significantly related to aggression, the combination of data from multiple risk assessment instruments may not result in clinically meaningful improvements in risk identification. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Improving awareness of the HCR-20 and risk assessment process.

BACKGROUND: In 2011 Mrs A assaulted two people, one who died. In the hours prior to the attack she made multiple attempts to gain help including attending accident and emergency, contact with an inpatient service and the police. Subsequent investigation highlighted that her risk was not well documented or understood. OBJECTIVE: This quality improvement project aimed to improve knowledge and awareness of HCR-20 risk assessments amongst mental health professionals. METHOD: The Quality Improvement approach was taken and various initiatives were introduced to improve knowledge of the location and purpose of the HCR-20 and to ensure that these risk assessments were regularly updated. RESULTS: The results indicated that knowledge relating to the HCR-20 significantly improved amongst staff and breaches of deadlines for updating these risk assessments dramatically declined after the induction of the interventions. CONCLUSION: Including the 'risk formulation' and 'scenarios' from the HCR-20 in clients' crisis plans, introducing training relating to the HCR-20, and including discussions relating to the HCR-20 at the beginning of CPA meetings resulted in improved MDT awareness and knowledge of the HCR-20. A broader understanding and awareness of risk factors enabled the service to move towards a culture of risk being everyone's business.

Charge Severity and Aggression during Competence Restoration.

Most competence restoration occurs in secure inpatient settings. As states struggle with strained resources and seek to best utilize restoration services, factors such as charge severity and violence risk remain key considerations in determining the appropriate setting for an individual's competence restoration. This study offers a quantitative analysis of aggressive behavior during inpatient restoration efforts and whether criminal charge severity correlates with inpatient aggression. Results of this study indicate that a substantial minority of defendants engaged in aggressive behavior and required restraint during the initial months of their hospitalizations. Most of those engaged in few episodes of aggression and required few episodes of restraint. Rates of aggression and restraint were higher in individuals with lower severity charges compared with those with higher severity charges. Courts and evaluators may have selected for a more disordered group of defendants with lower severity charges.

Prospective cohort study of the evaluation of patient benefit from the redevelopment of a complete national forensic mental health service: the Dundrum Forensic Redevelopment Evaluation Study (D-FOREST) protocol.

INTRODUCTION: Secure forensic mental health services are low volume, high cost services. They offer care and treatment to mentally disordered offenders who pose a high risk of serious violence to others. It is therefore incumbent on these services to systematically evaluate the outcomes of the care and treatment they deliver to ensure patient benefit in multiple domains. These should include physical and mental health outcomes, as well as offending related outcomes. The aim of Dundrum Forensic Redevelopment Evaluation Study (D-FOREST) is to complete a structured evaluation study of a complete national forensic mental health service, at the time of redevelopment of the National Forensic Mental Health Service for the Ireland. METHODS AND ANALYSIS: D-FOREST is a multisite, prospective observational cohort study. The study uses a combination of baseline and repeated measures, to evaluate patient benefit from admissions to forensic settings. Patients will be rated for physical health, mental health, offending behaviours and other recovery measures relevant to the forensic hospital setting at admission to the hospital and 6 monthly thereafter.Lagged causal model analysis will be used to assess the existence and significance of potential directed relationships between the baseline measures of symptomatology of schizophrenia and violence risk and final outcome namely length of stay. Time intervals including length of stay will be measured by median and 95% CI using Kaplan-Meier and Cox regression analyses and survival analyses. Patient related measures will be rated as changes from baseline using general estimating equations for repeated measures, analysis of variance, analysis of covariance or logistic regression. ETHICS AND DISSEMINATION: The study has received approval from the Research Ethics and Effectiveness Committee of the National Forensic Mental Health Service, Ireland. Results will be made available to the funder and to forensic psychiatry researchers via international conferences and peer-reviewed publications. TRIAL REGISTRATION NUMBER: NCT05074732.

The decision-making process in Swedish forensic psychiatric investigations.

Forensic psychiatric investigations in Sweden can have a major impact on the choice of sentence in criminal cases. Previous research shows that the decisions in several forensic fields, including forensic psychiatry, can be affected in a negative way by factors not relevant to the case. In the present study, the decision-making process of forensic psychiatric investigations was explored by using semi-structured interviews with experts (n = 38) and analyzing these interviews thematically. The results showed that the decision-making process is both complex and iterative, where the experts use and shape a substantial amount of information to reach their decisions. The experts work in teams, which add both benefits and risks to the process, and feel that particularly time constraints may reduce the quality of their decisions. In summary, the decision-making process of Swedish forensic psychiatric investigations creates a potential for high validity, but also contains risks for bias effects that could warrant further mitigation.

Identifying Predictors of Inpatient Verbal Aggression in a Forensic Psychiatric Setting Using a Tree-based Modeling Approach.

Inpatient violence poses a great risk to the health and well-being of other patients and members of staff. Previous research has shown that prevalence rates of violent behavior are particularly high in forensic psychiatric settings. Thus, the reliable identification of forensic inpatients who are particularly at risk for violent behavior is an important aspect of risk management. In the present study, we analyzed clinicians' assessments of N = 504 male and female inpatients of German forensic mental health institutions in order to identify risk factors for verbal institutional violence. Using a tree-based modeling approach, we found the following variables to be predictors of verbal aggression: gender, insight into the illness, number of prior admissions to psychiatric hospitals, and insight into the iniquity of the offence. A high number of prior admissions to psychiatric hospitals seems to be a risk factor for verbal aggression amongst men whereas it showed the opposite effect amongst women. Our results highlight the importance of dynamic risk factors, such as poor insight into the own illness, in the prediction of violent incidents. With regard to future research, we argue for a stronger emphasis on nonparametric models as well as on potential interaction effects of risk and protective factors.

Legal Admissibility of the Competence Assessment for Standing Trial for Defendants with Mental Retardation (CAST-MR).

The Competence Assessment for Standing Trial for Defendants with Mental Retardation (CAST-MR) was developed to assess competence to stand trial in defendants with Intellectual Disability. Although it remains the only validated instrument for this population, previous research has suggested it is rarely used by forensic examiners, a finding our survey of legal cases confirms. Initial validation studies provided some support for the instrument's reliability and validity. However, in both these and subsequent studies, there were significant limitations with respect to the size and representativeness of study samples, and therefore the associated interpretation of scores, such that questions remain as to whether the tool adequately assesses competence to stand trial in this population. In this paper, we review the research on the CAST-MR, discuss the strengths and limitations of the instrument, and debate its legal admissibility.

Domestic Mass Shooters: The Association With Unmedicated and Untreated Psychiatric Illness.

BACKGROUND: Given the relative lack of psychiatric information and data on the perpetrators of US mass shootings, the aim of our study was to understand who these "mass shooters" were and whether they had a psychiatric illness. If so, were they competently diagnosed, and if so, were they treated with appropriate medication for their diagnoses before the violence? METHODS: Because a prospective study of diagnosis and treatment could not, for obvious reasons, be carried out, we designed a retrospective, observational study of mass shooters, defined as those who killed 4 or more people with firearms between 1982 and 2012 or who killed 3 or more people with firearms between 2013 and 2019 in the United States. We used the Mother Jones database-a database of 115 persons identified as committing a mass shooting in the United States between January 1982 and September 2019. In the vast majority of the incidents identified in the database, the perpetrator died either during or shortly after the crime, leaving little reliable information about their history-especially psychiatric history. We focused on the 35 mass shooters who survived and for which legal proceedings were instituted because these cases presented the most reliable psychiatric information. For each of these 35 mass shootings, we interviewed forensic psychiatrists and forensic psychologists who examined the perpetrator after the crime and/or collected the testimony and reports by psychiatrist(s) at trial or in the postconviction proceedings contained in the court record. In addition, we reviewed available information from the court proceedings, public records, a videotaped interview of assailant by law enforcement, social media postings of the assailant, and writings of the assailant. After collecting the clinical information from multiple sources on each case to make a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnosis, we also completed a Sheehan Diagnostic Scale. After this, 20 additional cases where the assailant died at the crime were randomly selected form the remaining 80, to determine whether there were differences in psychiatric diagnoses and treatment between such assailants and those who survived. RESULTS: Twenty-eight of 35 cases in which the assailant survived had a psychiatric diagnosis-18 with schizophrenia, 3 with bipolar I disorders, 2 with delusional disorders, persecutory type, 2 with personality disorders (1 paranoid and 1 borderline), 2 with substance-related disorders without other psychiatric diagnoses, and 1 with posttraumatic stress disorder. Four had no psychiatric diagnosis, and in 3, we did not have enough information to make a diagnosis.Of 15 of 20 cases in which the assailant died, 8 had schizophrenia. None of those diagnosed with psychiatric illnesses were treated with medication. CONCLUSIONS: A significant proportion of mass shooters experienced unmedicated and untreated psychiatric disorder.

Criminología, proceso de determinación de salud y control penal del enfermo mental inimputable / Criminology, health determination process and criminal control of the mentally ill person not subject to criminal liability

Resumen La Psiquiatría Forense tienen dentro de sus retos la disposición de evaluar a aquellas personas que de manera pre o post delictiva presenten signos o síntomas que puedan ser susceptibles de una enfermedad psiquiátrica que puede transitar desde un debut o una persona con antecedentes de ser portador de una patología crónica en fase aguda, en este ámbito lo más importante es precisar si en el momento de la comisión del delito el autor tiene o no las capacidades de discernimiento y puede dirigir su conducta entre otras, luego la administración de justicia tiene la obligación de dictar sentencia dependiendo de los resultados del peritaje psiquiátrico. En este trabajo se realiza un análisis desde diferentes ángulos del problema centrados en las personas que son inimputables de responsabilidad penal, y de la visión de diferentes legisladores y criterios de especialistas incluyendo de manera general el beneficio social, médico terapéutico del enfermo mental que se convierte en una diana luego de ser interés jurídico penal.

Abstract The Forensic Psychiatry has within its challenges the provision to evaluate those people who, pre or post crime, present signs or symptoms that may be susceptible to a psychiatric disease that can transit from a debut or a person with a history of being a carrier of a chronic pathology in acute phase, in this area the most important thing is to specify whether or not at the time of the commission of the crime the author has the ability to discern and can direct their behavior among others, then the administration of justice has the obligation to pass sentence depending on the results of the psychiatric expertise. In this work we make an analysis from different angles of the problem centered in the people who are unimputable of criminal responsibility, and of the vision of different legislators and criteria of specialists including in a general way the social, therapeutic medical benefit of the mental patient that becomes a target after being a criminal legal interest.