Servicios universitarios en la interfaz del derecho y la salud mental: el caso de la Universidad de Cuenca, Ecuador / University services in the interface of the law and mental health: the case of the University of Cuenca, Ecuador / Serviços universitários na interface do direito e a saúde mental: o caso da Universidade da Cuenca, Equador

Introducción: Los sistemas de salud mental forense incluyen servicios universitarios relevantes para la prevención de la violencia y la protección de los derechos humanos. Objetivos: Describir el servicio del Instituto de Criminología, Criminalística e Intervención Psicosocial Familiar de la Universidad de Cuenca, Ecuador. Material y métodos: Estudio con diseño mixto, sección cuantitativa descriptiva de serie consecutiva de casos ingresados al instituto entre el 01/01/2015 y el 30/06/2015, y sección cualitativa con exploración de sus expedientes. Resultados: 52 casos ingresaron al instituto durante el período. Se estudiaron 72 personas, con promedio de edad de 22,6 años y distribución por sexo equitativa. El 88,5 % tuvieron requerimiento de intervención. Los temas principales detectados cualitativamente fueron"violencia intrafamiliar","protección infantil","protección juvenil","protección al discapacitado","asistencia a víctimas de abuso sexual","consulta comunitaria directa","fortalezas y debilidades del servicio pericial" y"consumo de alcohol". Conclusiones: Evaluados y asistidos presentan problemas complejos relacionados con la violencia y sus secuelas. El instituto brinda servicios a instituciones judiciales, municipales y directamente a la comunidad, y es una excelente fuente de experiencia académica.

Introduction: Forensic mental health systems include relevant university services for the prevention of violence and the protection of human services. Objectives: Describe the service offered by the"Instituto de Criminologia, Criminalística e Intervencion Psicosocial Familiar" of the Universidad de Cuenca, Ecuador. Material and methods: A study with a mixed design, a descriptive quantitative section with a consecutive series of cases admitted to the Institute between 01/01/2015 and 30/06/2015, and a qualitative one including its dossier exploration. Results: 52 persons were admitted to the institute during that period. 72 individuals with an average age of 22.6 years and an equitable distribution by genders were analyzed in that period. 88.5 % had an intervention requirement. The main subjects detected on a qualitative basis were"domestic violence","child protection","youth protection","protection of the disabled", assistance to victims of sexual abuse","direct community consultation","strengths and weakness of expertise services", and"alcohol consumption". Conclusions: Both evaluated and assisted individuals exhibit complex problems relating to violence and its negative effects. The Institute offers services to judicial and municipal institutions, and directly to the community itself. It is an excellent source of academic experience.

Introdução: Os sistemas da saúde mental forense incluem serviços universitários relevantes para a prevenção da violência e a proteção dos direitos humanos. Objetivos: Descrever o serviço do Instituto de Criminologia, Criminalística e Intervenção Psicosocial Familiar da Universidade de Cuenca, Equador. Material e métodos: Estudo com projeto misturado, seção quantitativa descritiva da série consecutiva dos casos ingressados ao instituto entre o 01/01/2015 e o 30/06/2015, e à seção qualitativa com exploração dos seus processos. Resultados. 52 casos ingressaram no instituto durante o período. 72 pessoas foram examinadas, com médio de idade de 22,6 anos e distribuição pelo sexo equitativa. O 88,5% tiveram exigência de intervenção. Os assuntos principais detectados qualitativamente foram"violência intrafamiliar","proteção infantil","proteção jovem","proteção á pessoa com deficiência","assistência às vítimas do abuso sexual","consulta comunitária direta","forças e fraquezas do serviço pericial" e"o consumo álcool". Conclusões. As pessoas avaliadas e assistidas apresentam-problemas complexos relacionados à violência e a suas sequelas. O instituto oferece serviços às instituições judiciais, municipais e diretamente à comunidade, e é uma fonte excelente da experiência académica.

The construct of psychopathy in a Chilean prison population

Objective:To test the four-factor model of the Hare Psychopathy Checklist - Revised (PCL-R) empirical construct of psychopathy in a Chilean prison population by using instruments that supply different types of data.Methods:Two hundred and nine male inmates of the Prison of Los Andes, Chile, were evaluated. Confirmatory factor analysis was carried out with the PCL-R and the Self-Report of Psychopathy - III - Short Form (SRP-III-SF).Results:The distributions of total PCL-R and SRP-III-SF scores were normal (Kolmorogov-Smirnov [K-S] = 1.04, p = 0.230; K-S = 0.812, p = 0.525, respectively), with means of 20.9±6.8 for the former and 61.6±15.2 for the latter. Model fit was good for the PCL-R (Tucker Lewis index [TLI] = 0.96; root mean square error of approximation [RMSEA] = 0.04) and for the SRP-SF (TLI = 0.94, RMSEA = 0.04).Conclusions:The results obtained with the PCL-R and the SRP-SF showed adequate fit to the empirical four-factor model of psychopathy and support this model. As foreseeable, fit was better for the PCL-R, which combines several sources of information.

La práctica de la evaluación del riesgo de violencia en España / The practice of violence risk assessment in Spain

Antecedentes. La valoración del riesgo de violencia es un requisito fundamental en la toma de decisiones profesionales que implican prevenir, intervenir o informar sobre la conducta de las personas. El uso de herramientas estructuradas de evaluación del riesgo de violencia ha mostrado mejoría en la precisión de las evaluaciones basadas exclusivamente en el juicio clínico o en la pericia de un experto en contextos psiquiátricos, penitenciarios y jurídicos. Objetivo. Este estudio presenta los resultados de la primera encuesta sobre las prácticas profesionales asociadas al uso de herramientas de evaluación del riesgo de violencia en España. Materiales y métodos. La información fue recogida mediante la administración de una encuesta en internet que fue distribuida por correo electrónico a los miembros de organizaciones profesionales. Resultados. De manera similar a los contextos profesionales del resto del mundo, las escalas de psicopatía de Robert Hare (Psychopathy Checklist-Revised y Psychopathy Checklist: Screening Version) y el Historical-Clinical-Risk Management-20 encabezaron la lista de las herramientas más usadas tanto por elección personal como por requisito institucional. Conclusiones. Se ofrecen datos novedosos sobre la prevalencia de uso y la utilidad percibida de las herramientas estructuradas, así como sobre otras cuestiones relacionadas a las prácticas profesionales de evaluación del riesgo de violencia en España que pueden orientar tanto a los profesionales de contextos sanitarios, correccionales y forenses, como a los responsables de las instituciones en la elección de las herramientas a implementar para asistirlos en la toma de decisiones.

Background. Violence risk assessment is a key requirement in professional decision making involving prevention, intervention or reporting on human behavior. The use of structured tools for violence risk assessment has shown to improve the accuracy of assessments based exclusively on clinical judgment or expertise in psychiatric, correctional and legal settings. Objectives. This study presents results of the first survey about professional practices associated with tools for violence risk assessment in Spain. Materials and methods. The information was collected by administering an online-based survey that was distributed by e-mail to members of professional organizations around the country. Results. As in professional contexts worldwide, the Robert Hare's psychopathy scales (Psychopathy Checklist-Revised and Psychopathy Checklist: Screening Version) and the Historical-Clinical-Risk Management-20 topped the list of the most used tools both by professional choice and institutional requirement. Conclusions. We provide novel data on the prevalence of use and the perceived utility of specific tools, as well as on other issues related to the professional practice of violence risk assessment in Spain, which can guide professional in the health care, correctional and forensic settings, as well as those responsible for decisions in institutions about choosing which tool to implement.

Homicidas juveniles en Bogotá, estudio de grupos focales / Young murderers in Bogotá, a focus groups study

Antecedentes. La violencia ha sido declarada un problema de salud pública mundial. En los últimos años, se ha visto un incremento alarmante de la violencia causada por adolescentes, reflejado en indicadores como el número de homicidios. Los adolescentes son victimarios y víctimas de muchos de estos actos violentos. Colombia no escapa a este fenómeno -donde el homicidio es la principal manera de muerte violenta- y se cuenta con pocos estudios en población homicida juvenil. Objetivo. Explorar comportamientos asociados a cometer homicidio en jóvenes escolarizados y población no escolarizada. Materiales y métodos. Estudio cualitativo mediante técnica de grupos focales. Resultados. Se encontró como el factor de riesgo más implicado la disponibilidad y uso de armas. Otros factores de riesgo afectan la disposición del joven homicida para tener un comportamiento criminal y las estrategias de control que son elegidas por el individuo. Dichos factores son apreciados de maneras distintas por los jóvenes homicidas y los no homicidas. Conclusión. Este estudio arroja información clave que puede ser utilizada en el diseño e implementación de estrategias para enfrentar el homicidio juvenil como problema de salud pública.

Background. Violence has been declared as a public health problem in the world. In the last years, there has been an alarming increase of the violence caused by adolescents. This has been reflected in several indicators as the number of homicides. Adolescents are both criminals and victims of many of these violent acts. Colombia has not escaped this phenomenon -being homicide its main way of violent death- and there is little specific data on juvenile homicidal population. Objective. To explore likely risk factors linked to homicide committed by two young populations: a schooled one and non-schooled one. Materials and methods. A qualitative study of two focus groups: one composed by young murderers and another by young non-murderers. Results. Studies show that the main risk factor is the access to and the use of weapons. Other risk factors affect the young's murder disposition to develop a criminal behaviour and the control strategies chosen by them. Such factors are interpreted in different ways by young murderers and non-murderers. Conclusions. This study gives important data which can be used in order to design and establish strategies to handle juvenile murder as a public health issue.

El juego patológico, las conductas ilegales y la potencialidad preventiva del servicio de ayuda telefónica en Argentina / [Pathological gambling, illegal behavior and the preventive potentiality of a helpline in Argentina].

INTRODUCTION: The evolution of Pathological Gambling has some important landmarks such as the age of onset, time elapse between onset and the perception of gambling consequences and their severity. These events encourage the exploration of the preventive potential of a helpline service for gamblers, thus the contact with this service might be the beginning of opportune intervention. OBJECTIVES: To describe and to compare the course and complications due to gambling reported by two Argentineans gambler population with access to different services: a sample of participants of a self-help group; and a sample of helpline clients. METHOD: A total of 268 gamblers were surveyed using a structured interview that included the Brief Questionnaire of Pathological Gambling. The sample was composed by 174 subjects attending self-help groups (Anonymous Gamblers); and 94 consecutive callers to a gambling helpline in Argentina. RESULTS: 76

of Anonymous Gamblers and 33

IC 3.6; 11.6). The disorder and the negative consequences were more severe in the Anonymous Gamblers group. Mean age of onset of gambling for helpline clients was 35 years and for Anonymous Gamblers 28. The mean time elapsed to perceiving economic problems was 5 years for helpline clients and 7 for Anonymous Gamblers. The findings support that helpline services promote the seek for help in those gamblers that have not yet reached the summit of the disorder.

Sistema de justicia juvenil en la provincia de Buenos Aires y métodos de evaluación / The Juvenile Justice System in the Province of Buenos Aires and evaluation methods

Los objetivos del presente artículo son describir el sistema de justicia juvenil en la provincia de Buenos Aires (Argentina) desde las perspectivas jurídica y ejecutiva, y comunicar avances científicos globales en la evaluación de los jóvenes que cometen actos disociales. En la provincia de Buenos Aires el sistema ha sido profundamente modificado en los últimos 15 años siguiendo las premisas de la Convención Internacional sobre los Derechos del Niño y dejando relegado el modelo del Patronato, que había regido previamente. Las instituciones encargadas de la ejecución de la intervención dispuesta por el Poder Judicial dependen actualmente de la Subsecretaria de Niñez y Adolescencia del Ministerio de Desarrollo Social y constan de centros cerrados, centros con régimen de semilibertad y centros de intervención ambulatoria (medidas alternativas a la prisión, tales como suspensión de juicio a prueba o tareas comunitarias). Las ciencias relacionadas con la salud mental y con el comportamiento vienen contribuyendo a la identificación de diversos factores influyentes en la conducta disocial y con el diseño de tipos de intervención para cada nivel de prevención. Sin embargo, hay una distancia importante entre las potencialidades del estado actual del conocimiento y la implementación. En las condiciones expuestas, queda configurado un período de transición que aún requiere optimización de la política de infancia con ajustes legislativos, judiciales y administrativos y con la capitalización de los aportes científicos.

The aim of this article is to describe the Justice System for juveniles in the Province of Buenos Aires, Argentina, from a legal and administrative perspective; and to review recent contributions to the assessment of youth with dissocial behaviors. During the last 15 years, the system has been deeply modified in order to fit the recommendations of the Convention on the Rights of the Child's. At present, the dispositions of the Courts are carried out by the Sub - Secretariat of Childhood and Youngsters of the Ministry of Social Development. This Secretariat has different facilities, such as closed, mixed centers that combine indoors and outdoors detention centers, open centers (in charge of the application of the sentences that bear alternatives to prison dispositions and community enforced services, etc). Studies from mental health and behavioral sciences have contributed to the identification of risk factors for dissocial behavior and for developing adequate interventions for each specific level of prevention. However, there is still a big gap between the state of the art and the practical issues related to it. Thus, the local system can be considered to be in transition period, and in need of adjustments not only in the legal codes but also in the application of the law, if policy improvement and better use of scientific knowledge is intended.

Incidência de conduta violenta e antissocial em população psiquiátrica forense / Incidence of violent and antisocial behavior in a forensic psychiatric population

INTRODUÇÃO: As consequências de comportamentos violentos e antissociais de internos em hospitais psiquiátricos são graves e podem determinar prejuízo ao tratamento do agressor. A falta de conhecimento sobre a incidência desse fenômeno e suas características favorece sua perpetuação. OBJETIVOS: Apresentar uma revisão bibliográfica atualizada do tema, informar a incidência de conduta violenta e antissocial em uma população manicomial e descrever a implementação de um método de registro sistematizado desse fenômeno. MÉTODO: A coorte foi selecionada dentro da população de pacientes do Instituto Psiquiátrico Forense Maurício Cardoso (IPFMC). Foi utilizada a Escala de Agressividade Declarada de Yudofsky (Overt Aggression Scale, OAS) e o Questionário de Seguimento de Tengström et al. Durante o período de seguimento de 1 ano, foram avaliados diariamente episódios de conduta violenta e antissocial, registrando-se os mesmos na escala e no questionário. A amostra em estudo foi composta de 68 pacientes homens selecionados de forma aleatória entre a população em cumprimento de medida de segurança no IPFMC. RESULTADOS: A incidência de comportamento violento/antissocial no período estudado foi de 200 episódios, envolvendo 50 pacientes. Houve predomínio de agressões e conduta antissocial durante o dia. As intervenções mais utilizadas foram manejo verbal, isolamento do paciente e aplicação de medicação intramuscular. CONCLUSÃO: Foi possível, pela primeira vez, medir a ocorrência de conduta violenta e antissocial em uma população psiquiátrica forense.

INTRODUCTION: The consequences of violent and antisocial behaviors among psychiatric hospital inpatients are serious and may affect the treatment of the aggressor. Lack of knowledge concerning the incidence of this phenomenon and its characteristics helps perpetuate the current scenario. OBJECTIVES: To present an updated literature review on the topic, to estimate the incidence of violent and antisocial behaviors in a mental hospital population, and to describe the implementation of a systematic method to record this phenomenon. METHOD: A cohort was selected among the psychiatric inpatients at Maurício Cardoso Forensic Psychiatry Institute (Instituto Psiquiátrico Forense Maurício Cardoso, IPFMC). Yudofsky's Overt Aggression Scale (OAS) and Tengström et al.'s Follow-Up Questionnaire were used. During a 1-year follow-up period, episodes of violent and antisocial behavior were evaluated daily and recorded on both the scale and the questionnaire. The population sample included 68 male patients randomly selected among the committed inpatients at IPFMC. RESULTS: The incidence of violent/antisocial behavior along the period assessed was 200 episodes involving 50 patients. Aggressions and antisocial behavior occurred mainly in daytime. The interventions most commonly used were verbal management, patient isolation, and intramuscular medication. CONCLUSION: For the first time, the occurrence of violent and antisocial behavior was measured in a forensic psychiatric population.