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1.
Saudi Med J ; 43(1): 98-104, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35022290

RESUMO

OBJECTIVES: To assess the knowledge and attitudes of physicians of different specialties, including psychiatrists, regarding forensic psychiatry to determine whether further modification or training is needed in the psychiatry residency program. METHODS: This cross-sectional study was carried out using a 3-page, 3-section questionnaire containing 21 questions disseminated randomly online via Google forms using social media platforms. The 482 participants were residents, specialists, and consultants of various specialties. The study was conducted between September 2020 and August 2021 in various tertiary hospitals across Saudi Arabia. RESULTS: A total of 482 physicians were recruited. The most common age group was 25-35 years, comprising mostly Saudis (62.4%). Based on the results, "poor" and "good" knowledge of forensic psychiatry was identified in 89% and 11% of the physicians, while "negative" and "positive" attitudes were identified in 16.4% and 83.6% of the physicians. CONCLUSION: Although the perspective of physicians regarding forensic psychiatry was found to be positive, their knowledge of the topic seems to be lacking.


Assuntos
Psiquiatria Legal , Médicos , Adulto , Estudos Transversais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Arábia Saudita , Inquéritos e Questionários
2.
Int J Offender Ther Comp Criminol ; 66(1): 84-97, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33478273

RESUMO

Experience Sampling Method (ESM) is a structured diary technique assessing variations in thoughts, mood, and psychiatric symptoms in everyday life. Research has provided ample evidence for the efficacy of the use of ESM in general psychiatry but its use in forensic psychiatry has been limited. Twenty forensic psychiatric patients participated. The PsyMate™ Device emitted a signal 10 times a day on six consecutive days, at unpredictable moments. After each "beep," the patients completed ESM forms assessing current context, thoughts, positive and negative affect, and psychotic experiences. Stress was measured using the average scores of the stress related items. Compliance rate was high (85% beeps responded). Activity stress was related to more negative affect, lower positive affect, and more psychotic symptoms. This finding was restricted to moments when a team member was present; not when patients were alone or with other patients. ESM can be useful in forensic psychiatry and give insights into the relationships between symptoms and mood in different contexts. In this study activity-related stress was contextualized. These findings can be used to personalize interventions.


Assuntos
Avaliação Momentânea Ecológica , Transtornos Psicóticos , Afeto , Psiquiatria Legal , Humanos , Amostragem
3.
4.
Vertex ; XXXII(151): 32-44, 2021 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-34783775

RESUMO

This study provides evidence on the inter-rater reliability and concurrent validity of the Historical, Clinical and Risk Management-20, Version 3 (HCR-20V3) in a sample of 35 patients admitted to a forensic psychiatric unit in Argentina. The HCR-20V3 showed significant correlations with the VRAG-R and the PCL: SV. HCR-20V3 was independently coded by two evaluators in 15 patients. The inter-rater reliability indices were moderate to excellent in the coding of presence of risk factors and in the estimation of the summary risk ratings of future violence and imminent violence, although ICC were non-significant for the summary risk rating of serious physical damage. These findings have implications for the HCR-20V3 implementation in local professional contexts and raise future research possibilities which could be relevant for decision-making in violence risk management with patients committed to legal security measures.


Assuntos
Psiquiatria Legal , Violência , Humanos , Reprodutibilidade dos Testes , Medição de Risco , Gestão de Riscos
5.
Vertex ; XXXII(152): 17-19, 2021 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-34783790

RESUMO

The COVID-19 has changed the way of working of forensic doctors, and the use of Information and Communication Technologies (ICTs) has gained relevance. But its implementation, for psychiatric-forensic evaluations, should comply with standards endorsed by the scientific community. Psycho-legal instruments are necessary in order to determine the procedural capacity of an accused person to stand trial. In the Justice of the Autonomous City of Buenos Aires (CABA), virtual proceedings are carried out, as the National Government decreed the obligatory social lockdown. In the case of the criminal jurisdiction, web platforms and electronic notifications are used for the processing of legal cases. However, in the practice of forensic medicine, there are difficulties in the use of ICTs to determine a person's capacity for criminal prosecution.


Assuntos
COVID-19 , Justiça Social , Controle de Doenças Transmissíveis , Comunicação , Psiquiatria Legal , Humanos , Competência Mental , SARS-CoV-2
6.
Tijdschr Psychiatr ; 63(10): 723-726, 2021.
Artigo em Holandês | MEDLINE | ID: mdl-34757611

RESUMO

BACKGROUND: Professionals in forensic psychiatry regularly face moral issues. For example, they have to make trade-offs between the treatment of a patient and society's security. AIM: To provide insight into some difficult, specifically forensic, dilemmas and show that forensic professionals benefit from structural ethics support. METHOD: Describing that ethics support, such as moral case deliberation, can provide support in making moral choices in forensic psychiatry. RESULTS: By participating in moral case deliberation, considerations are better substantiated and employees learn from and with each other. CONCLUSION: Moral case deliberation supports staff in jointly reflecting on moral dilemmas of the (forensic) workplace.


Assuntos
Psiquiatria Legal , Princípios Morais , Humanos
8.
Psychiatr Danub ; 33(Suppl 4): 535-540, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34718277

RESUMO

This paper discusses the assessment of psychopatic traits in perpetrators with schizofrenia in the light of common assumption that perpetrators with schizofrenia are not homogenic group but rather heterogenic group whose future risk does not rest exclusively on the psychopathology of the underlying disease. Our sample consists of 150 perperators with schizofrenia who commited a criminal act and were subjects of forensic evaluation in the University Hospital of Psychiatry Vrapce, Center for Forensic Psychiatry throughout a period of 11 years. All data were extracted from written evaluations. In our research, the assessment of psychopatic trait was performed by PCL-R (Psychopathy Checklist- Revised) - the assessment tool rarely used in Croatia. Data were analysed by methods of descriptive statistics and multivariant discriminatory analysis. Our results show that some of psychopatic traits exist in all of our evaluees, but with markedly different intensity. The average PCL-R score was 19.92 (SD=8.30), and by defining the cut off at 26, our subjects were divided into two groups: subjects with a higher level of psychopathy trait (High-P) and those with a lower level of psychopathy trait (Low-P). These two groups showed significant differences in all of the items. The confirmation of our hypothesis opens new areas for discussion and future research: problem of comorbidites in patients with schizofrenia in a forensic setting and a rationale for the routine usage of PCL-R in forensic evaluations.


Assuntos
Criminosos , Esquizofrenia , Transtorno da Personalidade Antissocial/epidemiologia , Comorbidade , Psiquiatria Legal , Humanos , Esquizofrenia/epidemiologia
9.
J Forensic Sci ; 66(6): 2092-2103, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34498734

RESUMO

Numerous studies have highlighted significant correlations between major psychiatric disorders and criminal behavior. However, the plethora of literature on criminality among patients with major psychiatric disorders originated in the West. The objective of the present paper is to review criminal behavior among individuals with mental illness in Arab countries. Attributes of individuals assessed by forensic psychiatric committees and identifying various aspects that may reinforce criminality among individuals with mental illness were considered. Following the PRISMA guidelines, a systematic review of literature from three databases (Scopus, PubMed, and Web of Science) was carried out. A total of 20 articles were included. The publications span between 1975 and 2020 and originated in seven different Arab countries including Egypt, Kuwait, Iraq, Saudi Arabia, Tunisia, Jordan, and Algeria. Individuals evaluated by forensic psychiatric committees were predominantly males. Excluding substance use disorder, psychotic disorders were the most commonly diagnosed disorders among individuals evaluated by forensic psychiatry committees. Concerning schizophrenia, concomitant substance use and nonadherence to therapy were significantly associated with increased criminality. The review demonstrates that substance use is certainly linked to violence. There is a significant association between mental illness and criminal behavior. Therefore, awareness of different characteristics and risk factors behind criminal behavior among mentally ill offenders could allow us to design and implement effective preventative measures. The Arab's contribution in this field of forensic psychiatry is relatively small. Indeed, further investigation and contributions from the Arab world are required.


Assuntos
Mundo Árabe , Crime , Comportamento Criminoso , Transtornos Mentais/epidemiologia , Distribuição por Idade , Vítimas de Crime , Escolaridade , Psiquiatria Legal , Humanos , Defesa por Insanidade , Estado Civil , Adesão à Medicação , Cooperação do Paciente , Prisioneiros , Distribuição por Sexo , Desemprego
12.
Crim Behav Ment Health ; 31(5): 321-330, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34523174

RESUMO

BACKGROUND: Treatment completion difficulties are common in forensic mental health settings and may have a profound impact on recidivism rates. AIMS: To test for associations between measures of risk and of security needs on the one hand and treatment non-completion on the other among male offender-patients in one medium security hospital. METHODS: We conducted a retrospective file study in a Flemish medium security hospital. A random sample of 25 treatment non-completers was compared to a random same-size sample of completers, each rated, blind to outcome, on the DUNDRUM-1 security needs scale from data recorded at the time of admission to the unit. 'Non-completion' was defined as any failure to complete treatment, whether staff-terminated or self-terminated; in Flanders, failure to comply with the judicial conditions of placement can result in re-imprisonment. We used binary logistic regression to test relationships between treatment completion/non-completion and security need, measured with the DUNDRUM-1, together with a range of possible confounding variables. RESULTS: Most patients had psychosis and/or personality disorder and often substance use disorders also. Treatment non-completion was invariably staff ordered because of security breaches. DUNDRUM-1 and PCL-R Facet 4 scores at the time of admission and HCR-20 scores during admission were significantly higher among non-completers than completers, but after binary logistic regression, only the DUNDRUM-1 rating was independently associated with non-completion. CONCLUSIONS: Our study showed that an admission DUNDRUM-1 rating, indicating levels of security need, co-varies only to a small extent with the historical items of the HCR-20, so may be regarded as measuring complementary domains. While conditions in Flanders at the time of the study complicated it in that medium security hospital units offered the highest level of hospital security available, the finding that non-completion of treatment was particularly likely when the DUNDRUM-1 indicated a higher security need than facilities could provide may have implications for all secure hospital services.


Assuntos
Criminosos , Transtornos Psicóticos , Psiquiatria Legal , Hospitalização , Humanos , Masculino , Estudos Retrospectivos
13.
J Forensic Sci ; 66(6): 2340-2353, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34403139

RESUMO

There is considerable evidence on the role of personality traits in the risk of criminal recidivism among schizophrenia patients, besides conventional risk factors. We evaluated the effects of psychopathy and biopsychosocial personality model on general criminal recidivism in schizophrenia patients. Ninety-four male DSM-5 diagnosed schizophrenia patients were recruited and classified into three groups according to the number of offenses since diagnosis: reoffenders (n = 32), Initial offenders (n = 31), and nonoffenders (n = 31). All subjects were evaluated by the Turkish versions of Psychopathy Checklist-Revised (PCL-R) and Temperament and Character Inventory-Revised (TCI-R). In Reoffenders, all subscale scores of PCL-R and Novelty seeking were the highest, while Self-directedness and Cooperativeness were the lowest. PCL-R Total, Factor 1 and Factor 2 positively correlated with Novelty Seeking, and negatively correlated with Harm Avoidance, Self-directedness, and Cooperativeness in offender patients. For criminal recidivism in offender patients, high PCL-R Total and Novelty Seeking, low Harm Avoidance, Self-directedness, and Cooperativeness, being unmarried, presence of childhood adversity, and younger age at the first offense were found to be significant predictors in univariate analyses; multivariate regression models revealed PCL-R Total and Persistence as the only significant predictors. These results suggest that certain dimensional personality evaluations combined with potential historical, clinical, and forensic risk factors can be employed in forensic settings to screen offender schizophrenia patients at an increased risk of recidivism and to take necessary precautions against further criminal behavior.


Assuntos
Criminosos/psicologia , Reincidência , Esquizofrenia , Adulto , Transtorno da Personalidade Antissocial/psicologia , Comportamento Criminoso , Estudos Transversais , Psiquiatria Legal , Humanos , Masculino , Determinação da Personalidade , Escalas de Graduação Psiquiátrica , Fatores de Risco , Psicologia do Esquizofrênico , Temperamento
14.
Int J Law Psychiatry ; 78: 101729, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34425379

RESUMO

The HCR-20, a widely used method of assessing and managing risk, relies on the structured professional judgement approach. This paper reports a narrative literature review of the HCR-20 studies to explore the applicability of the study results to the use of the HCR-20 in clinical practice. From a literature search using terms "HCR-20" and "HCR 20", 206 papers were included. Of studies using the HCR-20 version 2 (n = 191), 92% (n = 176) relied on variables based on scores derived by adding item scores, and 50% (n = 95) tested the HCR-20 using predictive validity methodology. Of the HCR-20 version 3 studies (n = 21), the "presence of risk factors" step was the most commonly examined (n = 18, 86%), but 2 of the 7 steps ("scenario planning" and "management") were not examined at all. Amongst those studies whose primary focus was on the HCR-20, 67% (n = 64/95) did so by assessing the predictive validity of the tool. Only one employed a design to test whether the use of the HCR-20 affected violence rates. The predominant study design provides support for the use of the HCR-20 as an actuarial tool, and there is limited empirical evidence in support of its effectiveness as a structured professional judgement approach to the assessment and management of the risk of violence.


Assuntos
Psiquiatria Legal , Violência , Humanos , Medição de Risco , Fatores de Risco , Gestão de Riscos
15.
Tijdschr Psychiatr ; 63(6): 419-424, 2021.
Artigo em Holandês | MEDLINE | ID: mdl-34231860

RESUMO

BACKGROUND: Incidents of self-harm by forensic psychiatric patients usually have a large impact on all those involved and self-harming behavior is an important predictor for violence towards others during treatment. AIM: To describe incidents of self-harm during the treatment of patients admitted to forensic psychiatry. METHOD: All incidents of self-harm during treatment in a forensic psychiatric center that were registered between 2008 and 2019 were analyzed and coded with respect to severity with the MOAS+. RESULTS: Between 2008 and 2019 299 incidents of self-harm were registered committed by 106 patients. Most of these incidents (87,6%) were classified as non-suicidal. Methods most often used were cutting themselves with glass, broken plates or mugs, a razor or knife and swallowing dangerous objects or liquids. There were ten cases of suicide, almost all by suffocation with a rope or belt. The majority of the incidents were coded as severe or extreme with the MOAS+. Female patients were overrepresented and they caused on average three times more incidents than male patients. CONCLUSION: Incidents of self-harm happen regularly in forensic psychiatry and are usually severe. More research is needed into the impact on all those involved, motivations and triggers for self-harming behavior and effective treatment of it.


Assuntos
Comportamento Autodestrutivo , Suicídio , Comportamento Perigoso , Feminino , Psiquiatria Legal , Humanos , Masculino , Comportamento Autodestrutivo/epidemiologia , Violência
17.
J Forensic Sci ; 66(5): 1797-1804, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34254683

RESUMO

This article adds to the growth in data-driven analyses seeking to compare samples of violent extremists with other violent populations of interest. While lone-actor terrorists and public mass murderers are frequently treated as distinct offender types, both engage (or attempt to engage) in largely public and highly publicized acts of violence and often use similar weapons. This article investigates the (dis)similarities between both offender types. We use a series of bivariate and multivariate statistical analyses to compare demographic, psychologic and behavioral variables across 71 lone-actor terrorists and 115 public mass murderers. The results show little distinction in sociodemographic profiles, but significant differences in (a) the degree to which they interact with co-ideologues (b) antecedent event behaviors and (c) the degree to which they leak information before the attack. Overall, our data inform the emerging idea that lone-actor terrorists and public mass shooters are not distinct offender types. There is more that unites them than divides them. Although the over-arching focus of our results are on the few variables that distinguish them, the vast majority (80%+), of the 180+ variables showed no significant difference. We discuss implications for threat assessment and management in the context of these results.


Assuntos
Comportamento Criminoso , Criminosos/psicologia , Homicídio/psicologia , Terrorismo/psicologia , Adulto , Criminosos/estatística & dados numéricos , Psiquiatria Legal , Psicologia Forense , Homicídio/estatística & dados numéricos , Humanos , Transtornos Mentais/epidemiologia , Terrorismo/estatística & dados numéricos
18.
Int J Circumpolar Health ; 80(1): 1954362, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34278974

RESUMO

There is a paucity of research on forensic psychiatry patients from Nunavut, including no published data concerning the prevalence and characterisation of patients in this territory. The lack of basic information hinders the evaluation of services and establishing best practices. The current paper aims to characterise forensic psychiatry patients from Nunavut and further the understanding of the challenges in organising forensic psychiatry healthcare in Nunavut. A retrospective chart review design was used to examine individuals from Nunavut who are engaged with the Ontario forensic psychiatry system. The sample included all Unfit to Stand Trial (26.7%) and Not Criminally Responsible (73.3%) patients (N = 15) under the jurisdiction of the Nunavut Review Board in a one-year period. The average distance between the patient's place of residence in Nunavut and the Ontario facilities was 2,517 km. Overall, 26.7% were living in Nunavut, 60.0% remained in Ontario, and 13.3% resided in Alberta. Results are presented for sociodemographics, forensic status, personal and familial history, psychiatric and criminal history, diagnoses, index offence characteristics, treatment, assessment tools, and aggression. The prevalence and many characteristics of forensic psychiatry patients from Nunavut differ from the rest of Canada and have important implications for the delivery of services.


Assuntos
Psiquiatria Legal , Transtornos Mentais , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Nunavut , Ontário/epidemiologia , Estudos Retrospectivos
19.
J Forensic Sci ; 66(6): 2329-2339, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34286852

RESUMO

Although the past research has indicated that features of borderline personality disorder (BPD) increase the risk for violence, much less research has examined the mediators of this relationship. This study examined the mediating roles that impulsivity and emotion dysregulation may play in explaining the relationship between BPD and violence. The Pathways to Desistance data were used in analyses. Generalized structural equation modeling was used to estimate the direct effect of BPD features on violent offending risk and to examine the mediating roles of emotion dysregulation and impulsivity. Results indicated that the direct effect of BPD symptoms on violence was mediated to non-significance by key constructs, and the magnitude of the effect was reduced by around 40%. The total indirect effect was significant, and the mediation was attributed mainly to impulsivity. This indicates the importance of structuring treatment programming for BPD patients around impulsivity for reducing violence. Programming focused on improving impulsivity among individuals suffering from BPD may aid in reducing violent offending among this population, particularly those prior histories of involvement with the criminal justice system.


Assuntos
Transtorno da Personalidade Borderline/psicologia , Regulação Emocional , Comportamento Impulsivo , Violência/psicologia , Conjuntos de Dados como Assunto , Psiquiatria Legal , Humanos , Masculino
20.
Artigo em Inglês | MEDLINE | ID: mdl-34207855

RESUMO

Knowledge on user experiences from mentally disordered offenders (MDOs) is still limited in a Danish context, especially regarding recovery from offences, severe mental illness, long-term admissions and often involuntarily contact with hospital psychiatry. The study is based on 34 semi-structured interviews with nine forensic patients exploring their experiences with personal recovery processes. The MDOs point out a significant number of elements and factors enhancing, supporting and limiting personal recovery processes. Long-term recovery processes for MDOs involve coming to terms with mental disorders as well as offences. Working with offender recovery implies addressing and understanding the index offence leading to psychiatric measurement as well as addressing risk and prevention of future crime. This coming to terms is an individual and deeply personal process and it often involves several and changing narratives. According to the informants, professionals play a crucial role in supporting recovery processes and maintaining hope and optimism over time. MDOs experience structural barriers limiting recovery potential, especially stigma or limited areas of participation. It is important not to focus solely on personal recovery as a one-dimensional individual process or responsibility, but as a process also marked by structural and organisational challenges.


Assuntos
Criminosos , Transtornos Mentais , Crime , Medicina Legal , Psiquiatria Legal , Humanos
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