The Preliminary Research for Making Judgment on Not Guilty by Reason of Insanity and Guilty but Mentally Ill / 대한법의학회지

BACK GROUND: Our object is to conduct a questionnaire research with psychiatrists who have the experience of mental examination to suggest judgment standard for Not Guilty by Reason of Insanity and Guilty But Mentally Ill(diminished capacity). In addition, this study is expected to reduce the gap between the judgments on Not Guilty by Reason of Insanity and Guilty But Mentally Ill. METHODS: In making judgment on Not Guilty by Reason of Insanity and Guilty But Mentally Ill by experts, the questionnaire research is conducted through e-mail on the judgment standard on each mental disorders. According to the definition of mental disability, the item that shows higher percentage than the items of cognitional ability and volitional ability is considered as the requirement for judging mental disability. RESULTS: In all of 7 major mental disorders and disease groups, the symptoms and characteristics of the disease and the range of the influence of the symptom on the case were higher in 2-4 times than the induced standard (cognitional ability and volitional ability) from the legal and academic definitions of mental disability. CONCLUSIONS: The criteria for judging normal or mental disability is the cognitional ability and volitional ability. The criteria for judging Not Guilty by Reason of Insanity and Guilty But Mentally Ill in mental disability is the symptom and characteristics of the disease and the range of the influence of the symptom on the case.

Clinical Features of Parricide in Patients with Schizophrenia / 신경정신의학

OBJECTIVES: This study aimed to describe the demographic, clinical and offense characteristics of the patients with schizophrenia who committed parricide. This study also investigated the risk factors of parricide by comparing with characteristics of stranger killers to prevent the tragic offense. METHODS: The sample consisted of 88 schizophrenic patients who committed homicide, 59 of them committed parricide and 29 of them killed strangers. Medical chart review regarding demographic and clinical characteristics as well as offense characteristics was conducted. The information that was difficult to be obtained through chart review was acquired by direct interview. RESULTS: Parricide group had earlier age of onset, more conflicts with the victims, more violence history toward victims and more offense provoking events than stranger killing group. Parricide group showed higher rate of past treatment than that of stranger killing group. However drug compliance at the time of offense was low in both groups. Offense provoking events in the parricide group included blaming, threatening a forced hospitalization or medication toward patients. The most common psychiatric symptoms associated with homicide were threat/control override (TCO) symptoms, delusional perception, commanding auditory hallucination and especially with parricide, Capgras syndrome (CS). CONCLUSION: Interaction between psychotic symptoms such as TCO, CS and underlying emotion toward victims are likely to be associated with parricide. Mental health professionals are expected to play an important role in preventing this tragic offense by active history taking of the violence and effective management with active caregiver education/intervention of intrafamilial conflicts.

Effect of Sex Offenders Treatment Programme on Cognitive and Emotional Characteristics of Mentally Ill Sex-Offenders / 신경정신의학

OBJECTIVES: This study was investigated to prove the effectiveness of Cognitive Behavior Treatment Program in mentally ill sex offenders and to be used as basic data for development of optimized treatment program for mentally ill sex offenders. METHODS: Cognitive Behavior Treatment Program was carried out over 10 weeks for 30 mentally ill sex offenders. With Interpersonal Responsiveness Index (IRI), UCLA Loneliness Scale (UCLALS), Coping Using Sex Inventory (CUSI) and Rape Myth Acceptance Scale (RMAS), the effectiveness of the treatment programme was evaluated. The data was analyzed with paired t-test. RESULTS: The results with 23 subjects showed no significant score changes after treatment program in IRI and UCLALS. However, there was a statistically significant improvement in the scores of CUSI and RMAS. CONCLUSION: Despite several limitations, this study showed significant effects of Cognitive Behavior Treatment Program on mentally-ill sex offenders. Therefore, treatment focused on the changes of cognitive and emotional characteristics of sex offenders along with the treatment for main psychiatric illness should be provided for mentally ill sex offenders to prevent recidivism. More studies to develope optimized treatment programme for mentally ill sex offenders are needed in the future.

Changes of Characteristics of Mentally Ill Criminals: Between 1990 and 2000 / 대한법의학회지

The authors reviewed the medical records and additional data of 460 mentally ill criminals who had referred to National Forensic Psychiatric Hospital, from January 1990 to December 1990 (60 cases) and from January 2000 and December 2000 (394 cases). The demographic factors, characteristics of crime, psychiatric diagnoses and psychiatric opinions and legal opinions , and legal opinions were analyzed and the results are as follows. 1) The frequency of crimes by female, high education level and single status increased. 2) As to the psychiatric diagnosis, schizophrenia decreased whereas substance- use disorder, mood disorder and personality disorder were increased and kleptomania and anxiety disorder were added. 3) As to the types and feature of crime, homicide and violence increased, whereas arson decreased and larcency, violation of harzadous substance and violation of narcotic drug were added. 4) As to victims of crime, the frequency of crimes committed to strangers increased whereas that of the family members and their lelatives were decreased. 5) As to motivation of crime, the frequency of impulsivity increased but psychotic symptoms such as delusion and hallucination significantly decreased. 6) More that half of psychiatric tests were referred from the court, but the agreement rate between the judge 's opinions and psychiatric opinions was decreased. In Conclusion, the changes of charateristics of mentally ill criminal were attributed to sociocultural changes for mentally ill criminals and implimeted in Social Protection Law. As the judges do not completely agree to the psychiatric opinions, the close cooperation between the judges and the psychiatrist as legal adviser should be necessory for mentally ill criminals.

Development and Validation of DIS-IV, Korean Version / 신경정신의학

OBJECTIVE: Appearance of DSM-IV has influenced greatly on the nosological classification of mental disorder, not considered as revised one of DSM-III-R but a new criteria. DIS-IV has been developed after revision of DIS-III in consideration of various changes in DSM-IV. This study is to develop and validate the DIS-IV, Korean version to activate Korean psychiatric research much more and to modivate more frequent international collaborative study. METHOD: Translation committee produced DIS-IV, Korean version through all the procedures of translation, back-translation, confirmation of retained original meaning of the English version, adaptation to Korean linguistic usage and preliminary study. Four medical students were trained during DIS-IV training course that retained the same contents and methods as of Washington University. Inter-rater reliability was measured by comparison between two diagnoses made from two interviewer who rated one patient at the same time. Procedural validity was measured by comparison between lay-interviewer's diagnosis and psychiatrist's diagnosis which were made after independent DIS-IV using interview. Subjects were 124 patients who were being treated at two University Hospital and National Forensic Psychiatric Hospital between January, 2000 and August, 2000. RESULTS: Average kappa value of inter-rater reliability was 0.74. Diagnoses showing over 0.7 in kappa value were bipolar I disorder, generalized anxiety disorder, depressive disorder, obsessive-compulsive disorder, oppositional defiant disorder, pain disorder, pathological gambling, post-traumatic stress disorder, specific phobia and almost all substance use disorder or substance- related disorder. Procedural validity, that compared lay-interviewer's diagnosis and psychiatrist's diagnosis, were as follows;For all diagnoses, sensitivity, specificity and kappa were 67.6%, 98.3% and 0.69. For diagnoses of substance use disorder or substance- related disorder, sensitivity, specificity and kappa were 79%, 98% and 0.77. For other diagnoses except substance use disorder or substance- related disorder, sensitivity, specificity and kappa were 60.5%, 98% and 0.64. This results are almost at the same level as that of Robins and her colleagues who first reported reliability and validity of DIS. CONCLUSION: We think that DIS-IV, Korean version has higher reliability and validity. It is very important that diagnoses of substance use disorder and substance-related disorder can be made reliably and validly by this instrument. We expect that it can help to improve diagnosability of mental disorder, activate clinical research and increase international scientific communication.

The Characteristics of Adolescent Substance Abuse by the Age of the First Exposure to Substances / 신경정신의학

OBJECTIVE: To determine whether the age of the first exposure to substances influences the characteristics of substance abuse. METHOD: Ninety seven adolescent boys in a substance abuse treatment facility were evaluated by using questionnaires, individual diagnostic interviews, and psychology tests. They were classified into 3 groups, preadolescence group(PA), early adolescence group(EA), and middle adolescence group (MA) according to the age of the first exposure to substances, and the data were statistically analyzed by SPSS 9.0. RESULTS: The average age was 16.4+/-1.2 years. There were 39 in PA, 29 in EA, and 29 in MA. In comparison to EA, PA showed higher frequency in substance use, substance dependence, and positive family history of alcohol abuse. In comparison to MA, PA had higher frequency in troubles in interpersonal relationship, functional impairment, dependence on substances, withdrawal symptoms, amount of alcohol and gas consumed, positive family history of alcohol abuse. presence of comorbid psychiatric disorders, and higher score in K-subscale of MMPI. PA also used more variety of substances more frequently, and had shorter duration before starting the second substance. In comparison to MA, EA showed higher frequency of substance use, functional impairment, trouble in interpersonal relationship, diagnoses of substance dependence, and shorter duration before starting the second substance. However, less EA were from disorganized families. Among the 3 groups, there were no statistically meaningful differences in combined use of alcohol, trial of abstinence, duration of abstinence, child abuse history, family support, intelligence, and frequency and duration of running away from home. CONCLUSION: Earlier exposure to substances may lead to more serious problems of drug abuse. Earlier drug prevention education for adolescents should be provided.

The Characteristics of Schizophrenia to Commit Homicide / 대한법의학회지

The authors analyzed the mental evaluation reports for 5 years from 1995 to 1999, done in the Forensic Psychiatric Hospital for the schizophrenic patients who were prosecuted for homicide. The survey was done for the schizophrenics' sex, age, marital status, job, the first or second offense, a residential status, offense place, weapons used, chief motive for homicide, whether he or she was drunken at the time of commission of homicide, the victims' characteristics, the age of the onset of disease, previous psychiatric treatment history, previous criminal history, the duration of schizophrenic disease. In the age of onset of disease, 20-29 years old were the most, 30 cases of 67%. In the psychiatric treatment history for the chronic cases, there's statistical significance. For the chronics, it can be said that the experiences of psychiatric treatment were statistically significant. For the chief motive of homicide, delusion and hallucination were of 44%, but angers were 18 cases(40%) and excitements were 3 cases. What is specially noteworthy is the angers and excitements, consisting of 46.7% of all. And for the chronic cases, delusion and hallucination were the major motive with statistical significance.

A Forensic Psychiatric Study for Substance-Related Offenders / 대한법의학회지

OBJECT: This study examined the demographic characteristics, abused substance types, comorbid psychiatric diagnosis and associated crimes of substance-related offenders. METHOD: We surveyed 205 offenders of substance-related crime from court. RESULT: Substance-related offenders were all men and most of them were unemployed, living alone in the major city and mean age was 27.9+/-5.77years. 78.5% frequently abused inhalants like adhesives and 17.1% abused the methamphetamine. They violated the 1 or more times and the classification of crimes was violence, rape and rape-injury, larceny, arson. Substance-related offenders had comorbid psychiatric disorder ; 26 of them had personality disorder, 23 had mood disorder and 13 had psychotic disorder. Mean hospital day was 14.8+/-6.55 months. CONCLUSION: Substance-related offenders were young single men without a job living major city. They had comorbid psychiatric disorder and high risk to commit crime.

A Study of the Clinical characteristics and Psychopathology of Kleptomania offenders / 대한법의학회지

OBJECT: This study was devised to examine the demographic characteristics, psychopathology and associated psychiatric disorder of the Kleptomania offenders. METHODS: Kleptomania offenders who was referred to the National Forensic Psychiatric Hospital was concerned. RESULTS: Most of the Kleptomania offenders were women(92.6%, N=25) and lived alone(71.4%, N=20). In their first stealing, 25(92.6%) reported stressful situation just before stealing behavior but at admission 14(51.9%) is reported. Kleptomania experienced physical and sexual abuse during childhood; 9(33.3%) in case of physical abuse and 12(44.4%) in case of sexual abuse. At admission, Most of them complains of depressive mood(88.9%, N=24) and anxiety(88.9%, M=24), and any disorders like delusion was rare(7.4%, M=2). Most of Kleptomania offenders were comorbid psychiatric disorder; mood disorder(48.1%, N=13), personality disorder(40.7%, N=11), psychotic disorder(25.9%, N=7), anxiety disorder(14.8%, N=4) and alcohol dependence(14.8%, N=4). 24(88.9%) responded to the psychiatric treatment and 16(59.2%) of them had good prognosis. CONCLUSION: Most of Kleptomania offenders were single women and were abused physically or sexually during childhood. They had comorbid psychiatric disorder that responded to the psychiatric treatment and had good prognosis.

A Forensic Psychiatric Study for Stalking Offenders / 대한법의학회지

OBJECT: This study was devised to examine the demographic characteristics, behaviors, psychopathology and associated crimes of stalking offenders. METHODS: It concerned 50 stalking offenders referred to the National Forensic Psychiatric Hospital for the forensic evaluation. RESULTS: Most of the stalking offenders were men(78.0%, N=39), and many were unemployed(74.0%, N=37),;70.0%(N=35) had lived alone and they committed the serious crime. Victims included the colleagues or acquaintances(48.0%, N=24), past intimate persons(22.0%, N=11), stars or celebrities(16.0%, N=8), and strangers(14.0%, N=7). The duration of stalking was from 2 month to 20 years (mean= 37.7 month). Three types of stalking offenders were: love obsessional type, delusional type and revenge type. Delusional disorder(40.0%, N=20) was the most frequent, and the next frequent was schizophrenia(22.0%, N=11). CONCLUSION: Most stalking offenders found single and socially isolated male, and tend to attack the victim directly or indirectly. Appropriate legal and therapeutic interventions are necessary in order to prevent such serious crime as stalking.

A Study of Murder in Schizophrenic Patients Characteristics of the murders of family and nonfamily homicides / 대한법의학회지

Sixty schizophrenia patients who committed homicide and detained after January 1, 1993 were divided in two groups, depending on whether their victim was a family member or not. Below conclusions were deduced from the comparison of the two groups in terms including demographic characteristics, onset and duration of illness, IQ score, suicidal attempts, history of alcohol/drug abuse or past crime, neuropsychiatric ward admission history, living circumstance, conflict with the victim, and adolescent conducting behavior. 1. More in the family homiciding patients (FHP) group lived alone due their unmarried, divorced, or separated marital status than those in the non-family homiciding patients (NFHP) group. More in the FHP group were in married state than those in NFHP group. 2. More in the NFHP group stayed alone apart from their family, while more in the FHP group lived with their family. 3. Those in the NFHP group show more frequent suicidal attempts than those in the FHP group, implying they have difficulties in the control of their impulsive behaviors. 4. To prevent the crime, it is essential for the government to practice the systematic support and care of the schizophrenia patients who are living alone, especially those without relative.

A Study for the Mentally Disordered Offenders in Korea : A Statistic Review for 11 years of the Forensic Psychiatric Hospital / 대한법의학회지

The nationwide spreaded institutionalized mental disordered offenders admitted in the several mental hospitals were transfered in one time after opening in November 3, 1987 until the end of 1988. In 1989, new admitted MDOs were 5.8%, 107 among total 1849, 203 MDOs(11%) were admitted newly in 1997. The new admitted MDOs were increased every year. The diagnosis of total 1849 mental disordered offenders to be admitted during 11 years from November 3, 1987 to December 31, 1997.Schizophrenia is 69.8%, Epilepsy 0%, Personality disorders 4.0%, Mental Retardation 4.0%, Alcohol-related disorder 3.0%, Substance-related disorder(other than alcohol) 2.0%. The crimes of total 1849 MDOs for 11 years are as follows; Homicide 33.2%, Violence 19.2%, Manslaughter 12.5%, Stealing 8.1%, Arson 6.4%, Robbery 2.5%, Rape 2.2%,II-legal Substance Abuse 1.6%. Year average recidivism of MDOs for 11 years are as follows:1st crime 70.6%, 2nd crime 12.3%, 3rd crime 4.9%, 4th crime 3.7%, 5th crime 8.5%. The number 77(6.8%) among 1141 total discharged MDOs are admitted again after discharge from the Forensic Psychiatric Hospital. The readmitted 77 MDOs for 11 years according to crimes are as follows: Stealing 30(38.9%), Substance Abuse 14(18.2%), Violence 11(14.3%), Arson 5(7.8%), Robbery 5(6.5%), Rape 5(6.5%), Homicide 4(5.2%). The readmitted 77 MDOs for 11 years according to crimes are as follows:Stealing 30(38.9%), Substance Abuse 14(18.2%), Violence 11(14.3%), Arson 6(7.8%), Robbery 5(6.5%), Rape 5(6.5%), Homicide 4(5.2%). The readmitted 77 MDOs for 11 years according to diagnosis are as follows: Schizophrenia 36(46.7%), Substance Abuse 15(19.5%), Kleptomaina 6(7.8%), Mental Retardation 4(5.2%), Personality disorders 4(5.2%), Epilesy 1(1.3%), Delusional disorder 2(2.6%), Bipolar Disorder 2(2.6%), Alcohol dependency 1(1.3%). II. Mental evaluation for Criminal Responsibility The diagnostic classification of total 1422 Mental Evaluation for 11 years are as follows: Schizophenia 431(30.3%), Alcohol-related disorder 205(14.4%), Mood disorder 188(13.2%), Personality disorders 124(8.7%), Mental retardation 108(7.6%), Delusional disorder 67(4.7%), and mental disorder due to general medical condition 42(3.0%). The number sentenced to insanity are 597(44.9%) among total 1331, diminished capacity 546(41%), and 'normal' 188(14.1%).

A Psychiatric Review on Rapes That had been Referred for Forensic Evaluation / 대한법의학회지

In this study, analysis was made upon 60 rapes that had been referred to Forensic Mental Hospital for forensic evaluation during three years between 1. January. 1995 and 31. December.1997 (1) In sex offender's age, 30-39 years old were the most, 48.3% and, in victim's age, 10-19 years old were the most, 36.7%, and 50% of sex offenders were unemployed, and 30% were high school graduates and 68.3% were single. (2) 48.3% of offenders had no history of inpatient hospitalization. In case of inpatient hospitalization, inpatient duration of between 6 months and 1 year was the most, 16.7%. 43.3% of sex offenders had history of previous offenses and 53.4% had no history of previous offenses. Thirty percent of sex offenders were found out as victim's neighbor, and 28.3% were stranger to victims. (3) In offense time, 12:00-18:00 was the most, 36.7% and in offense season, spring was the most, 36.7% and 35% occurred at victim's residence. (4) 98.3% of sex offenses were done by one offender and 96.7% of victims were raped alone. 36.7% of victims were students. (5) 56.7% of sex offenses were rapes only, but 31.7% of sexual offenses were accompanied with violence and injury. 21.7% of sex offenders were diagnosed in alcohol-related disorders, and forensic evaluations showed that 58.3% of sex offenders were feeble-minded.

A Clinical Study of Firesetters in Forensic Psychiatric Hospital / 대한법의학회지

OBJECTIVES: The main purpose of this study was aimed at examining the epidemiological and clinical data of firesetters in Konju forensic psychiatric hospital. METHOD: The thirty firesetters were admitted at Konju forensic psychiatric hospital from January. 1, 1998 to December. 1, 1995, They carefully investigated from January. 3, 1996 to July. 31, 1996 through the methods of psychiatric interview, chart review, the written judgement review and telephone interview. RESULTS: There are significant differences in education level and intelligence quotient among three groups. Prevalence of febrile convulsion, nail biting, and enuresis are highest among the firesettes. Alcohol-related family history is significantly high in firesetters. Most frequently reported motivation of firesetters were psychosis, and anger or revenge.

A Study of Psychiatric Accidents in Korea / 대한법의학회지

Followings are results from analyzing 263 responses out of 1,000 survey questionaires, which were mailed to Korean psychiatrists, for purpose to discover current status of psychiatric accidents in Korea, and to find appropriate solutions. 1) More accidents were experienced by 30-40 years-old psychiatrists than any other age level. More experience in practice they had, more accidents were experienced. 2) 74.5% of responding psychiatrists reported that they had experienced accidents. The rate has steadily increased. 3) Quite a few accidents were involved with schizophrenic patients, who were between 20-30 years of age level 4) 58% of reported accidents were suicides, which was the highest rate. In legal suit regarding malpractice, the highest rate of 47.9% were suicides, as well. It calls special attention to careful evaluation and treatment of suicidal patients. 5) More accidents tended to be dealt in private rather than in legal. Accidents tended into legal suits asked for more compensation. 40.4% of accidents upset patient's family to take actions. It is suggested that Special Case Settlement Policy be established and Accident Dispute Intervention Committee be actively involved for efficient solutions against accidents.

The legal-psychiatric consideration for the Psychiatric disability evaluation: guides to the evaluation of permanent impairment / 신경정신의학

No abstract available.