Nuevas demandas ejecutorias y periciales para la salud pública en la reforma penal cubana de 2022 / New Executive and Judicial Expert Demands for Public Health in 2022 Cuban Penal Reform

Introducción: Durante 2022 ocurrió la reforma del sistema penal cubano, materializada en tres nuevas leyes básicas: Código Penal y las del proceso y la ejecución penales. Ello demandó respuestas organizativas del Ministerio de Salud Pública cubano, en especial por la ampliación de tipos de aseguramiento penal terapéutico a adictos e inimputables en unidades de salud y de las tareas periciales. Objetivo: Identificar las demandas para el sistema de salud en las nuevas leyes penales, en especial para la salud mental. Posición: Desde propuestas previas al proceso legislativo y la asesoría durante este, se visionó precozmente la necesidad de nuevas regulaciones para las interdependientes actividades periciales y asistenciales de respuesta del sistema de salud a la reforma penal. Fomentar anticipadamente el intercambio académico entre derecho penal y psiquiatría, favoreció la sinergia intersectorial, asumir la asesoría al proceso legislativo y elaborar, en corto plazo, propuestas normativas sólidas al sistema de salud, acordes a sus objetivos y estructura. Metodológicamente fueron oportunas las consultas a expertos. Conclusiones: Se considera que el vínculo intencionado previo entre sistemas de salud y penal favorece que las propuestas legislativas tengan una base más científica y una respuesta organizativa, más eficiente y sinérgica desde el sistema de salud a las demandas identificadas en nuevas leyes penales(AU)

Introduction: During 2022, the reform of the Cuban penal system occurred, which materialized in three new basic laws: The Penal Code, Penal Procedures Law and Penal Execution Law. This reform demanded organizational responses from the Cuban Ministry of Public Health in those tasks for health units and judicial expert, especially the expansion of types of therapeutic penal coverage to addicts and those who cannot be held accountable. Objective: To identify the demands of the health system in the new criminal laws, especially for mental health. Position: Beginning with the previous proposals to the legislative reform and counselling, the need for new regulations for the interdependent expert and assistance activities of the health system that respond to the penal reform was timely envisioned. The early promotion of academic exchange between the penal law and psychiatry favored intersectoral synergy, advice to the legislative process and the development, in the short term, of solid regulatory proposals for the health system, in accordance with its objectives and structure. Methodologically, consultations with experts were appropriate. Conclusions: It is considered that the previous intentional relationship between health and criminal systems favors that the legislative proposals have more scientific basis beside an organizational, more efficient and synergistic response from the health system to the demands identified in new criminal laws(AU)

Research Progress and Application Prospect of Facial Micro-Expression Analysis in Forensic Psychiatry / 法医学杂志

Research on facial micro-expression analysis has been going on for decades. Micro-expression can reflect the true emotions of individuals, and it has important application value in assisting auxiliary diagnosis and disease monitoring of mental disorders. In recent years, the development of artificial intelligence and big data technology has made the automatic recognition of micro-expressions possible, which will make micro-expression analysis more convenient and more widely used. This paper reviews the development of facial micro-expression analysis and its application in forensic psychiatry, to look into further application prospects and development direction.

A perícia psiquiátrica no processo penal da pessoa com transtorno mental em conflito com a lei: uma análise sob a luz da sociologia das ausências / The psychiatric expertise in criminal proceedings of the person with a mental disorder in conflict with the law: an analysis in the light of the sociology of absences

A pessoa com transtorno mental que comete delito pode ter a pena substituída por medida de segurança, se confirmado por laudo psiquiátrico forense que no momento do crime não tinha discernimento sobre a ilicitude do fato, conforme Código Penal brasileiro. Essa medida de segurança pode ser internação em Hospital de Custódia e Tratamento Psiquiátrico ou tratamento ambulatorial. Não existe limite de prazo para cumprimento dessa medida, e aquele que é custodiado à internação não tem prazo para deixar esse hospital. A perícia psiquiátrica forense tem grande influência na decisão judicial, pois o perito que conclui sobre a imputabilidade penal, com base no método biopsicológico, avaliação do nexo de causalidade entre transtorno mental e delito, e da periculosidade do indivíduo. Essa pessoa acaba por ser duplamente estigmatizada, pelo transtorno mental e pelo crime cometido, e por ser silenciada, tornando-se socialmente invisível. Este estudo apresenta como objetivo descrever como ocorre a perícia psiquiátrica no processo penal e seus desdobramentos para a aplicação da medida de segurança, identificando as características apresentadas nos laudos forenses e as situações de invisibilidade das pessoas com transtorno mental que cometeram delitos. Trata-se de pesquisa qualitativa descritiva com análise documental, tendo como fonte primária os laudos psiquiátricos. O percurso metodológico não é restrito, segue processo de "garimpagem" que foi dividido em 3 etapas: identificação e coleta de documentos; organização do material coletado; procedimento da análise documental. Ao final foram selecionados 37 laudos. Os resultados foram classificados em 4 categorias: categoria tempo da perícia identificou diversos fatores que envolvem o decurso de tempos relacionado ao exame pericial, dentre eles, 5 perícias realizadas após 365 dias do delito; na categoria sociodemográfica, o perfil dos periciandos eram, na maioria, do sexo masculino, solteiros, brancos, sem filhos, idade até 40 anos, muitos sequer concluíram o ensino fundamental e exerciam profissões que exigem pouca ou nenhuma qualificação técnica e educação; na categoria saúde mental, prevaleceu a indicação de preexistência de transtorno mental ao delito e a maioria dos periciandos já fez tratamento psiquiátrico, incluindo internação, sendo comum a descontinuidade do tratamento; na categoria conclusão pericial, a maioria dos periciandos foram considerados imputáveis, o tratamento ambulatorial foi o mais indicado, e apresentou prevalência de crimes contra patrimônio. Os resultados foram discutidos com dados encontrados na literatura e com base no marco teórico da Sociologia das Ausências. Identificou-se a produção de não existência dos periciandos sob as formas de inferior, improdutivo e ignorante, por meio das monoculturas da naturalização das diferenças, dos critérios de produtividade capitalista e dos saber e do rigor do saber, respectivamente. É necessário desconstruir essas monoculturas e substituí-las pelas ecologias dos reconhecimentos, da produtividade e de saberes, respectivamente. Tanto a perícia quanto os laudos precisam ser descontruídos e reconstruídos sob novos olhares de saberes científicos [psiquiatria e direito] e saberes não científicos, para que a não existência dessas pessoas não seja produzida

A person with a mental disorder who commits a crime may have the sentence replaced as a security measure, if confirmed by a forensic psychiatric report that, at the time of the crime, they had no discernment about the illegality of the fact, according to the Brazilian Penal Code. This security measure can be hospitalisation in a Hospital of Custody and Psychiatric Treatment or outpatient treatment. There is no deadline for compliance with this measure, and those who are compulsorily hospitalised have no deadline to leave that hospital. Forensic psychiatric expertise has a great influence on the decision of the judge, as the expert who concludes on criminal responsibility, based on the biopsychological method, assessment of the causal link between mental disorder and the crime committed, and dangerousness. This person ends up being doubly stigmatized, due to the mental disorder and the crime committed, and for being silenced, becoming socially invisible. This study aims to describe how psychiatric expertise occurs in the criminal process and its consequences for the application of the security measure, identifying the characteristics presented in the forensic reports and the situations of invisibility of people with mental disorders who have committed crimes. This is descriptive qualitative research with documental analysis, having psychiatric reports as a primary source. The methodological course is not restricted and it follows a "mining" process, which was divided into 3 stages: identification and document collection; organization of the material collected; document analysis procedure. In the end, 37 reports were selected. The results were classified into 4 categories: time of expertise category, identified several factors that involve the time course related to the expert examination, among them, 5 psychiatric expertise took place after 365 days of the crime; in the sociodemographic category, the profile of examinees was mostly male, single, white, without children, and aged up to 40 years old, many of them had not even completed elementary school and worked in professions that require little or no technical qualification and education; in the mental health category, the indication of a pre-existing mental disorder to the crime prevailed and most of the examinees had already undergone psychiatric treatment, including hospitalisation, with discontinuity of treatment being common; in the expert conclusion category, most examinees were considered imputable, outpatient treatment was the most indicated and showed a prevalence of crimes against property. The results were discussed with data found in the literature and based on the theoretical reference of the Sociology of Absences. The production of the non-existence of the examinees in the forms of inferior, unproductive, and ignorant was identified, through the monocultures of the naturalization of differences, the criteria of capitalist productivity and knowledge and the rigor of knowledge, respectively. It is necessary to deconstruct these monocultures and replace them with ecologies of recognition, productivity, and knowledge, respectively. Both the expertise and the reports need to be deconstructed and reconstructed under new perspectives of scientific knowledge [psychiatry and law] and non-scientific knowledge so that the non-existence of these people is not produced

Identidade profissional do psicólogo judiciário: um estudo sobre configurações identitárias / Forensic psychologist´s professional identity: a study about identity configurations / Identidad profesional del psicólogo forense: un estudio sobre configuraciones de identidad

Este estudo objetivou descrever a identidade profissional de psicólogos judiciários, partindo do cenário contemporâneo da Psicologia Jurídica brasileira, contexto que envolve crises e conflitos sobre a forma de responder a atribuições e demandas do campo legal. Pela perspectiva da sociologia das identidades profissionais de Claude Dubar, sustenta-se a hipótese de que a identidade profissional do psicólogo judiciário depende de estratégias de compatibilização entre o pertencimento à categoria e as atribuições legais e institucionais. Participaram 95 psicólogos do quadro ativo do Tribunal de Justiça de São Paulo, que responderam a um formulário online sobre a percepção de si e do campo de atuação. Os dados foram submetidos à análise de conteúdo. Os resultados indicam a saliência da avaliação psicológica e da interdisciplinaridade na identidade profissional, e as rupturas identitárias diante de práticas verificatórias. Tais achados apontam a necessidade de participação da categoria na construção de suas atribuições; e dificuldades para o exercício das funções por limitações à autonomia profissional.(AU)

This study aimed to describe the professional identity of forensic psychologists, considering Brazil's Legal Psychology contemporary scenario which relates to a critical issues on how practitioners respond the demands of the legal system. Based on Claude Dubar's sociology of professional identities, we support the hypothesis that forensic psychologists' professional identity depends on strategies of compatibilization between belonging their reference group and the institutional attributions. There were 95 participants, all from the current staff of the Court of Justice of the state of São Paulo, who answered an online form. The data were subjected to content analysis. The results indicate a professional identity with noted salience on psychological assessment and interdisciplinarity, and the identity crises regarding verification practices. Such findings highlight the importance of practitioners taking part on the construction of their own tasks.(AU)

Este estudio tuvo como objetivo describir la identidad profesional de los psicólogos forenses, considerando el escenario de la Psicología Jurídica brasileña, que se relaciona con una crisis sobre si estos profesionales responden a las demandas del sistema legal. Teniendo en cuenta la sociología de las identidades profesionales de Claude Dubar, sostenemos la hipótesis de que la identidad profesional de los psicólogos forenses depende de estrategias de compatibilización entre la pertenencia a su grupo profesional y a instituciones. Participaron 95 psicólogos, quienes actuaban en el Tribunal de Justicia del Estado de São Paulo, a los cuales se aplicó un formulario en línea. Los datos se sometieron a análisis de contenido. Los resultados indican una identidad profesional saliente en cuanto a la evaluación psicológica y la interdisciplinariedad, pero también crisis de identidad en relación con las prácticas de verificación. Tales resultados señalan la importancia de que la categoría participe en la construcción de sus propias atribuciones.(AU)

Perspectivas éticas e legais em perícias de psiquiatria forense / Ethical and legal perspectives of forensic psychiatry in expert testimony / Perspectivas éticas y legales en pericias de psiquiatría forense

Resumo Conhecer o paradigma ético que fundamenta o código moral da medicina é fundamental para atuar não só na assistência, mas também em processo pericial. A partir de revisão da literatura, propõe-se avaliar a maneira como os quatro princípios éticos fundamentais (beneficência, não maleficência, autonomia e justiça) se aplicam antes, durante e após a perícia psiquiátrica, como perito ou como assistente técnico. Novos desafios éticos vêm surgindo na psiquiatria forense. Com a pandemia de covid-19, a tecnologia foi adotada para permitir a prática da telemedicina, mas ainda se debate se seria suficiente para promover avaliação pericial psiquiátrica adequada. Considerando a complexidade da área, cada situação deve ser analisada de forma individual e abrangente, sendo recomendável buscar auxílio para debater as perspectivas éticas e legais das perícias psiquiátricas quando necessário.

Abstract Knowing the ethical paradigm that bases the medicine moral code is fundamental to act not only in care but also in the expert testimony process. From a revision of the literature, we propose to evaluate the way the four fundamental ethical principles (beneficence, nonmaleficence, autonomy, and justice) apply before, during, and after the psychiatric expert testimony, be it as expert or as technical assistant. New ethical challenges have been appearing in forensic psychiatry. With the COVID-19 pandemic, technology was adopted to allow the practice of telemedicine, but debates still occur if that would suffice for an adequate psychiatric expert testimony evaluation. Considering the complexity of the area, each situation must be analyzed in an individualized and all-encompassing way and seeking help to debate the ethical and legal perspectives of psychiatric expert testimonies is recommended when necessary.

Resumen Conocer el paradigma ético que subyace en el código moral de la medicina es fundamental para actuar no solo en la asistencia, sino también en el proceso pericial. A partir de una revisión bibliográfica, se propone evaluar cómo se aplican los cuatro principios éticos fundamentales (beneficencia, no maleficencia, autonomía y justicia) antes, durante y después de la pericia psiquiátrica, ya sea como perito o como asistente técnico. Están surgiendo nuevos desafíos éticos en la psiquiatría forense. Con la pandemia del Covid-19, se utilizó la tecnología para permitir la práctica de la telemedicina, pero aún está en debate si esto es suficiente para promover una adecuada evaluación psiquiátrica forense. Considerando la complejidad del área, se debe analizar cada situación de manera individual e integral y, cuando sea necesario, buscar ayuda para debatir las perspectivas éticas y legales de la pericia psiquiátrica.

The Legal Correspondence of Sexual Self-Defense Capability Assessment / 法医学杂志

OBJECTIVES@#To understand the legal application and case deposition of assessment opinions of sexual self-defense capability, and to explore the necessity of legal correspondence in the sexual defense capability assessment.@*METHODS@#According to the self-made questionnaire, the cases of sexual self-defense capability assessment completed by the Academy of Forensic Science from January 1, 2012 to December 31, 2018 were statistically analyzed through telephone interviews and referrals.@*RESULTS@#Among the 69 cases, 3 cases (4.3%) had complete sexual self-defense capability, 30 cases (43.5%) had weakened sexual self-defense capability, 32 cases (46.2%) had no sexual self-defense capability, and 4 cases (5.8%) were not suitable for assessment. Among the 30 cases with weakened sexual self-defense ability, 15 cases were filed and investigated by public security authorities for rape and 15 cases were not. The inconsistent rate of disposition was 1∶1. Among the 15 rape cases filed and investigated by the public security authorities, 10 cases were arrested and prosecuted by the procuratorate and sentenced to fixed-term imprisonment by the court, while the other 5 cases were not arrested and prosecuted by the procuratorate, with an inconsistent rate of disposition being 2∶1.@*CONCLUSIONS@#The legal application of the assessment opinion on the weakening of sexual self-defense capability is inconsistent, and the judicial disposition is confusing. It is imperative to unify and correspond the classification of sexual self-defense capability with the legal requirements.

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.

Psicologia, loucura e justiça: os laudos psicológicos produzidos no IPF / Psychology, madness, and justice: the psychological reports produced by the Forensic Psychiatric Institute Maurício Cardoso / Psicología, locura y justicia: los informes psicológicos producidos por el Instituto Psiquiátrico Forense Maurício Cardoso

Resumo Este artigo busca compreender, desde uma perspectiva arqueogenealógica, a produção de laudos psicológicos no contexto do Instituto Psiquiátrico Forense Maurício Cardoso (IPF) entre 1989 e 2016. Para tal, realiza-se um breve percorrido histórico da reforma do sistema penal do final do século XVIII, com o estabelecimento de uma nova racionalidade penal e dos tensionamentos que o crime sem razão produz neste regime de verdade. Com isso, pretende-se situar a produção dos laudos psicológicos no campo de relações entre os discursos jurídico e psiquiátrico. Foram analisadas 263 papeletas administrativas catalogadas no arquivo do IPF, o que resultou na seleção de 43 documentos produzidos por psicólogos para compor o escopo da pesquisa. Os laudos foram divididos em cinco períodos, nos quais podem ser identificados três regimes discursivos: um regime explicativo, fundado nas relações entre desenvolvimento, instinto e perigo; um regime marcadamente disciplinar, de vigilância e relato; e, por fim, um regime discursivo, que funciona por meio de uma modulação do poder de cuidado.(AU)

Abstract This article aims to understand the production of psychological reports in the Forensic Psychiatric Institute (FPI) Maurício Cardoso between 1989 and 2016 from an archaeogenealogical perspective. To locate the production of psychological reports in the field of relations between judicial and psychiatric discourses, this study performed a brief historical review of the 18th-century penal system reform, which established a new criminal rationality and heightened the tensions produced by crimes without reason in this regime of truth. From the 263 administrative folders cataloged in the FPI archive, 43 documents written by psychologists were selected for the research scope. These documents were analyzed and divided into five different moments, indicating three discursive regimes: an explanatory one, founded on the relations between development, instinct, and danger; a disciplinary regime of surveillance and reporting; and a discursive regime that works through the modulation of care power.(AU)

Resumen Este artículo pretende comprender, desde la perspectiva arqueogenealógica, la producción de informes psicológicos por el Instituto Psiquiátrico Forense Maurício Cardoso (IPF) en el período entre 1989 y 2016. Para ello, se realiza un breve recorrido histórico de la reforma del sistema penal de finales del siglo XVIII, con el establecimiento de una nueva racionalidad penal y de las tensiones que el delito sin razón produce en este régimen de verdad. Lo que se propone es situar la producción de los informes psicológicos en el campo de relaciones entre los discursos jurídico y psiquiátrico. Se analizaron 263 papeletas administrativas catalogadas en el IPF, lo que resultó en la selección de 43 documentos producidos por psicólogos para componer el corpus de la investigación. Los informes se dividieron en cinco períodos en que pueden ser identificados tres regímenes discursivos: el explicativo fundado en las relaciones entre desarrollo, instinto y peligro; el marcadamente disciplinario, de vigilancia y relato; y, por fin, el discursivo que funciona mediante una modulación del poder de cuidado.(AU)

Dentro e fora: tecendo reflexões sobre um hospital de custódia / Inside and out: casting reflections upon a custody hospital / Dentro y fuera: tejiendo reflexiones en un hospital de custodia

Neste trabalho, buscamos refletir se em um Hospital de Custódia e Tratamento Psiquiátrico (HCTP), atualmente, existem ou não ações consoantes ao processo da Reforma Psiquiátrica brasileira. Para ilustrar essa questão, é apresentado um caso clínico sobre um paciente acompanhado durante estágio em um HCTP. Consideramos que os princípios e objetivos do movimento de Reforma Psiquiátrica, em geral, não são referências aos modelos de funcionamento dos HCTP, mas ressaltamos a existência de ações psicossociais sendo feitas nesse tipo de instituição.

In this work we seek to reflect on whether, in a Custody and Psychiatric Treatment Hospital (CPTH), there currently are actions in accordance with the process of Brazilian Psychiatric Reform or not. To illustrate this issue, a clinical case is presented about a patient accompanied during internship at this institution. We consider that the principles and objectives of the psychiatric reform movement, in general, are not references to the functioning models of the CPTH, but we emphasize the existence of psychosocial actions being practiced within this institution.

En este artículo buscamos indentificar la existencia o no de acciones basadas en la reforma psiquiátrica brasileña en un Hospital de Custodia y Tratamiento Psiquiátrico (HCTP). Para ilustrar esa cuestión, se presenta un caso clínico sobre un paciente acompañado durante las prácticas en un HCTP. Consideramos que los principios y objetivos del movimiento de Reforma Psiquiátrica, en general, no actúan como referencia a los modelos de funcionamiento de los HCTP. Sin embargo, resaltamos La existencia de acciones psicosociales realizadas dentro de esa institución.

Analysis of Consistency between Forensic Psychiatry Identification Diagnosis and Clinical Diagnosis of 1 369 Cases / 法医学杂志

Objective To explore the consistency between identification diagnosis and pre-identification clinical diagnosis of patients with mental disorder undergoing forensic psychiatry identification. Methods The identification data of 1 369 appraised individuals who underwent criminal responsibility identification carried out by the Forensic Institute of Second Affiliated Hospital of Jining Medical University from 2014 to 2017 were collected retrospectively using self-designed investigation data sorting table. A comparative analysis of the mental disorder diagnosis results of expert opinion and past clinical diagnosis results was made. Results Among 1 369 appraised individuals, 964 cases （70.4%） were identified and diagnosed with mental disorder and 405 cases （29.6%） without mental disorder. Among the former, 63.3% （610 cases） were clinically diagnosed, which was higher than 43.2% （175 cases, P<0.05） in the latter. Among the various mental disorders that had been identified and diagnosed, patients with hysteria, stress, and neurosis had the highest proportion of clinical diagnoses （86.7%）, while patients with mental retardation had the lowest proportion of clinical diagnoses （9.6%）. Schizophrenia had the highest overall consistency rate of identification diagnosis and clinical diagnosis （98.4%）, while personality and behavior disorder had the lowest （33.3%）. The overall consistency rate between clinical diagnosis and identification diagnosis of the mental disorder group was 84.1%, and the Kappa value was 0.759. Compared with clinical diagnosis, the consistency rate between inpatient diagnosis and identification diagnosis was higher （85.9%, P<0.05）. Conclusion In forensic psychiatry identification that provides data of past clinical diagnosis and treatment, a high consistency between identification diagnosis and clinical diagnosis of the appraised individual who is identified and diagnosed with mental disorder exists. Clinical diagnosis （especially the inpatient diagnosis） has a relatively good reference value for forensic psychiatry identification.

Analysis of 123 Cases of Forensic Psychiatry Testimony of Individuals Suspected of Road Traffic Offences / 法医学杂志

Objective To explore the characteristics of individuals with mental disorders suspected of road traffic offences and to find their differences from normal offenders, in order to regulate mental disorder patients' driving activities and prevent road traffic offences. Methods One hundred and twenty-three cases of forensic psychiatry testimony of individuals suspected of road traffic offences between 2014 and 2019 from the West China Forensic Center of Sichuan Province were collected. Fisher exact probability test was used to compare the differences between offenders with mental disorders and without mental disorders in terms of demographic characteristics, criminological characteristics, psychiatric characteristics and criminal responsibilities. Results There was no statistical significance in the differences of demographic characteristics, vehicles and kinds of alcohol between the two groups （P>0.05）. The main type of road traffic related crimes committed by offenders with mental disorders was risky driving and were mainly evaluated as partial criminal responsibility, whereas most offenders without mental disorders committed crime of causing traffic casualties and all were evaluated as full criminal responsibility. There was statistical significance in the differences of the types of crime and the criminal responsibility rating between the two groups （P<0.05）. Meanwhile, patients with mental disorders were characterized by long course of disease and irregular treatment, and individuals diagnosed as having mental disorders caused by psychoactive substances accounted for a large proportion. Conclusion There are differences in the characteristics of road traffic-related crimes between mental disorder patients and normal people. It is of great practical significance for reducing road traffic offences to evaluate whether the individuals with mental disorders are fit for driving.

Institucionalização prolongada, transtornos mentais e violência: uma revisão científica sobre o tema / Prolonged institutionalization, mental disorders and violence: a scientific review on the topic

Resumo Trata-se de uma revisão de literatura sobre institucionalização prolongada, transtornos mentais e violência. Uma busca sistematizada foi realizada nos principais bancos de dados e foram analisados trabalhos dos últimos 22 anos. Os resultados foram divididos em dois grupos: "Estudos relacionando fatores ligados à predição/risco de violência e institucionalização" e "Estudos relacionando risco de violência e desassistência/desinstitucionalização". Verificou-se que a doença mental isoladamente não é fator diretamente associado ao maior risco de violência, que fatores relacionados à própria institucionalização e à assistência com privação de liberdade influenciam a predição de violência. Conclui-se que abordagens humanizadas, multiprofissionais e com equipe treinada, aliadas ao gerenciamento dos reais fatores de risco de violência, contribuirão para uma melhor assistência e menor necessidade de institucionalização.

Abstract This study is a review of institutionalization, mental disorders and violence. A systematic search was performed in major databases, focusing on studies from the last twenty-two years. The results were divided into two groups: 'studies on factors related to the risk of violence/prediction and institutionalization' and 'studies on the risk of violence and deinstitutionalization/inadequate mental treatment'. We found that mental illness is not directly associated with high risk of violence. Specific details of the institutionalization and assistance with deprivation of liberty are related to violent behavior. We concluded that humanized, multiprofessional approaches and trained staff, combined with the management of real risk factors of violence can contribute to a better health assistance and reduce the need for institutionalization.

Factors Influencing the Initiation Time of Forensic Psychiatric Assessment of Criminal Cases in Hunan Province / 法医学杂志

Objective To discuss the related factors influencing the initiation time of forensic psychiatric assessment by analysis of the initiation time of forensic psychiatric assessment of criminal cases in Hunan Province. Methods Related data in assessment files of criminal cases accepted by 8 forensic psychiatric assessment institutions in Hunan Province from January 1, 2011 to December 31, 2016 were extracted. The Logistic regression analysis was used to explore the factors influencing the initiation time of forensic psychiatric assessment. After using property score matching （PSM） to control the influence of confounding factors, the efficiency of public security organs to initiate assessments of suspects with （without） mental disorders and with （without） responsibilities were compared. Results A total of 4 346 cases were included. The Logistic regression analysis suggested that the factors independently related to the initiation time of assessment include： cause of assessment, nationality of the assessed, history of diagnosis and treatment of mental illnesses, history of crimes, history of drug abuse, and status of alcohol consumption before the crime （all P<0.05）. The initiation time of assessment of suspects diagnosed with mental disorder was shorter than those with none （P<0.05）; the initiation time of assessment of suspects without criminal responsibility was shorter than those with responsibility （P<0.05）. After using PSM to control confounding factors, the differences above still existed. Conclusion The cause of assessment, nationality of the assessed, history of diagnosis and treatment of mental illnesses, history of crimes, history of drug abuse, and status of alcohol consumption before the crime are factors that influence the efficiency of public security organs to initiate forensic psychiatric assessments. Under the current assessment initiation mode, forensic psychiatric assessment of suspects who have mental disorders, especially those with no responsibility may be given priority to initiate.

The psycho-social and clinical profile of women referred for psycho-legal evaluation to forensic mental health units in South Africa

Background: There is a paucity of research on women offenders in the South African context, particularly those referred for forensic psychiatric observation. Little is known about their life histories, the nature of their offences or the psycho-social contexts that enable, or are antecedents to, women's criminal offending. Aims: This research study, the largest of its kind in South Africa, examined the psycho-social contexts within which women offenders referred for psychiatric evaluation come to commit offences. The profiles of both offenders and victims, as well as reasons for referral and forensic mental health outcomes, were investigated. Methods: A retrospective record review of 573 cases, spanning a 12-year review period, from six different forensic psychiatric units in South Africa, was conducted. Results: The findings describe a population of women offenders who come from backgrounds of socio-demographic and socio-economic adversity, with relatively high pre-offence incidences of being victims of abuse themselves, with significant levels of mental ill-health and alcohol abuse permeating their life histories. The majority of index offences which led to court-ordered forensic evaluations were for violent offences against the person, with murder being the single most common index offence in the sample. Most victims of violence were known to the accused. There were also relatively high rates of psychotic and mood-spectrum disorders present, with relatively low rates of personality disorders. The majority of women were deemed to be trial competent and criminally responsible in relation to their index offences. Conclusion: It is recommended that more standardised and gender-sensitive forensic mental health assessment approaches, documentation and reporting be employed throughout the country. Future research should compare male and female offending patterns and forensic mental health profile

Conducta homicida en el trastorno esquizotípico. Presentación de un caso / Homicidal behavior in schizotypical disorder. A case presentation

Introducción: El trastorno esquizotípico se manifiesta desde edades tempranas como un patrón general de déficit social e interpersonal, comportamiento excéntrico, capacidad reducida para las relaciones personales y distorsiones cognoscitivas, incomprensibles psicológicamente. Objetivo: Fundamentar la responsabilidad médico-legal de un caso de trastorno esquizotípico que cometió homicidio. Presentación de caso: Individuo de 22 años, soltero, sin hijos, técnico medio, sin historia de trastornos mentales que es peritado por psiquiatría forense debido a que agredió a su abuelo materno con un arma blanca, y causó la muerte. Se le realizó examen psiquiátrico, se aplicó la Escala de Valoración de Impulsividad, se realizó electroencefalograma y valoración psicológica, que incluyó la aplicación de las pruebas proyectivas Bender, Machover y Rorschach. El diagnóstico propuesto por el equipo evaluador fue trastorno esquizotípico, sin enajenación mental. Conclusiones: El trastorno esquizotípico no es un diagnóstico frecuente en Psiquiatría. Cuando se involucra en conductas delictivas, estas ocurren en solitario y suelen estar relacionadas con agresiones hacia otras personas. Es determinante de semi-imputatibilidad o imputabilidad y no se recomienda su permanencia en régimen penitenciario(AU)

Introduction: Schizotypical disorder appears at very early ages as a general pattern of social and interpersonal deficit; eccentric behavior; reduced capacity to maintain personal relations; and cognitive distortions, which are psychologically inexplicable. Objective: To establish the medico-legal implications in a case of schizotypical personality disorder that committed homicide. Case presentation: A 22 years old individual, single, without children, technician, without history of mental disorders who is studied by Forensic Psychiatry because he attacked his maternal grandfather with a knife, which caused his death. Psychiatric examination was done; the Impulsiveness Scale was applied; and an enlectroencephalogram (EEG) and a psychological evaluation were carried out, which included Bender, Machover, and Rorschach tests. The evaluating staff made the diagnosis of Schizotypical disorder, without mental derangement. Conclusions: Schizotypical disorder is not a frequent diagnosis in Psychiatry. When it is involved in criminal behaviors, they occur in isolation and they are usually related to attacks to other persons. It is a determinant condition of semi-imputability or imputability. Prison system is not recommended(AU)

Expressões da sexualidade e de gênero na injunção crime-loucura: engendramentos moralizantes no tratamento do paciente judiciário / Expressions of sexuality and gender at the interface between crime and madness: moralizing conceptions in the treatment of the "criminally insane" patient / Expresiones de sexualidad y género en procedimientos judiciales relacionados con casos de crimen-locura: sentencias moralizadoras en el trato a pacientes judiciales

Este artigo tem por objetivo analisar a forma como as expressões da sexualidade e de gênero emergem nos trâmites judiciais que definem os destinos dos sujeitos na injunção crime-loucura. Para isso, explora os processos penais referentes às pessoas em sofrimento mental que cometeram crimes, os chamados pacientes judiciários, que recebem uma medida de segurança. Utilizando-se da genealogia como aporte metodológico, adentra-se nas condições de proveniência e de emergência do "anormal", figura produzida e esquadrinhada pelo discurso médico-jurídico. Foram analisadas seis peças judiciais, focando principalmente os laudos psiquiátricos de pessoas não heterossexuais e/ou não cisgêneras que receberam uma medida de segurança. A análise do córpus indica que a base teórico-conceitual na qual se sustentam os pressupostos da medida de segurança se concentra no laudo psiquiátrico. A análise do discurso médico-jurídico aponta para uma valoração moral das expressões da sexualidade e de gênero do paciente judiciário considerado "desviante". Por fim, sinalizam-se alternativas de produção de novos modelos de tratamento para o paciente judiciário, que buscam superar a ficção da presunção de periculosidade como base pretensamente científica, revisando a inimputabilidade como dispositivo jurídico que viola direitos inalienáveis dos sujeitos na injunção crime-loucura.

This article aims to analyze how expressions of sexuality and gender emerge in the legal proceedings that determine the fate of individuals at the interface between crime and madness. The text explores the criminal proceedings against persons in mental distress that have committed crimes, or so-called "criminally insane" patients, and who are subject to security measures. Using genealogy as the methodological approach, the article analyzes the conditions underlying the source and emergence of the "abnormal", a figure produced and scrutinized by forensic medical discourse. Six court briefs were analyzed, focusing especially on the psychiatric reports pertaining to non-heterosexual and/or non-cisgender persons that were subjected to security measures. Analysis of the textual corpus indicates that the theoretical and conceptual basis for the assumptions in the security measures focuses on the forensic psychiatric report. The analysis of the forensic medical discourse points to a moral judgment of the expressions of sexuality and gender in the criminally insane patient, considered "deviant". Finally, the article signals alternatives for the production of new treatment modalities for the criminally insane patient, seeking to supplant the presumption of danger to society as a purportedly scientific concept, reviewing non-imputability as a legal device that violates the inalienable rights of individuals at the interface between crime and madness.

El objetivo de este trabajo ha sido analizar la forma en la que surgen expresiones de sexualidad y género en procedimientos judiciales, que definen las sentencias a sujetos durante los trámites judiciales relacionados con casos de crimen-locura. Para tal fin, investiga procesos penales en relación con personas que padecen enfermedades mentales y que cometieron crímenes, denominados pacientes judiciales, a quienes se les otorgan medidas de seguridad. Utilizando la genealogía como aporte metodológico, se adentra en las condiciones de procedencia y emergencia de lo "anormal", figura creada y escudriñada dentro del discurso médico-jurídico. Se analizaron seis autos judiciales, centrándose principalmente en los dictámenes psiquiátricos de personas no heterosexuales y/o no cisgénero, a quienes se les otorgó medidas de seguridad. El análisis del corpus indica que la base teórico-conceptual, en la que se basan los presupuestos de las medidas de seguridad, se concentra en el dictamen psiquiátrico. El análisis del discurso médico-jurídico apunta a una valoración moral de las expresiones de la sexualidad y de género del paciente judicial, considerado como "desviado". Finalmente, se señalan alternativas para la producción de nuevos modelos de tratamiento en el caso del paciente judicial, que buscan superar la ficción de la presunción de peligrosidad, como base presuntamente científica, revisando la inimputabilidad como dispositivo jurídico que viola derechos inalienables de los individuos en los procedimientos judiciales relacionados con casos de crimen-locura.

Forensic psychiatric assessment process and outcome in state patients in KwaZulu-Natal, South Africa

Background: Individuals who were charged with a serious offence may be referred by courts for forensic psychiatric assessment. The court may declare them as state patients if they are found unfit to stand trial or not criminally responsible because of mental illness or defect. In forensic psychiatry practice, there may be challenges in the forensic psychiatric observation process, and discrepancies may occur between the clinician report and the court's decision. Objectives: To describe elements of the forensic psychiatric observation and discuss the legal correlates associated with the admission of state patients. Method: A retrospective study of the forensic psychiatric observation records of 91 newly admitted state patients at a forensic unit in KwaZulu-Natal over a 3-year period. Results: A total of 71 state patients (78.02%) were found not fit to stand trial and 10 patients (10.99%) were not criminally responsible. Nine patients (9.89%) were fit to stand trial and criminally responsible but still declared state patients and 13 state patients (14.29%) did not commit a serious offence. There was correlation for diagnosis between the assessing and the treating psychiatrists. Conclusion: The findings of the forensic observation were not always considered by the courts. Individuals found fit to stand trial, those found criminally responsible and those who did not commit serious crimes were declared state patients. A better understanding of legal dispositions for mentally ill offenders and an active collaboration between judicial and mental health systems may contribute in developing national guidelines for observation and admission of state patients

A psicologia forense por trás de John Emil List / A forensic psychology behind John Emil List / La psicología forense por tras de John Emil List

Cada vez mais encontramos, no dia a dia, sujeitos com intensa precariedade de sentimentos e com uma dificuldade enorme de representações simbólicas. Estamos diante de um cenário de falhas na constituição psíquica dos sujeitos e não conseguimos compreender os motivos dessas falhas; apenas julgamos, sem esclarecimento dos significados. O presente artigo pretende apresentar aspectos relevantes sobre a personalidade de sujeitos sem empatia e por isso aborda a história, feita através da literatura disponível, de John Emil List, um criminoso que cometeu familicídio, para discussão de fragmentos de sua história pessoal e criminal, de acordo com relatos da literatura e teóricos nas diversas áreas do conhecimento, tais como: Psicologia Forense, Direito e Psiquiatria Forense. O presente artigo busca, através desses métodos, compreender de forma multidisciplinar os fatores de risco que conduzem determinados indivíduos à prática criminal, particularmente o familicídio.(AU)

Increasingly we encounter in our daily lives people with an intense precariousness of feelings and with difficulties in symbolic representation. We stand before a scenario of failures in the subject's psychic constitution and cannot understand the reasons for these failures; we solely judge, without clarification of meanings. This article intends to show relevant aspects of the personality of subjects with no empathy, therefore bringing the story, done through available literature, of John Emil List, a criminal who committed familicide. Based on literature and theorists' accounts, the story leads to a discussion with real and theoretical fragments in several fields of knowledge, such as: Forensic Psychology, Law and Forensic Psychiatry. This article aims, through the chosen methods and in a multidisciplinary fashion, to provide a deeper understanding on risk factor that lead certain subjects to criminal practices, particularly familicide.(AU)

Cada vez más encontramos, en el día a día, sujetos con intensa precariedad de sentimientos y con una dificultad enorme de representaciones simbólicas. Estamos ante un escenario de fallas en la constitución psíquica de los sujetos y no conseguimos comprenderlos motivos de esas fallas; sólo juzgamos, sin aclaración de los significados. El presente artículo pretende presentar aspectos relevantes sobre la personalidad de sujetos sin empatía y por eso aborda la historia, hecha a través de la literatura disponible, de John Emil List, un criminal que cometió el familiar, para discusión de fragmentos de su historia personal y criminal , de acuerdo con relatos de la literatura y teóricos en las diversas áreas del conocimiento, tales como: Psicología Forense, Derecho y Psiquiatría Forense. El presente artículo busca, a través de estos métodos, comprender de forma multidisciplinaria los factores de riesgo que conducen determinados individuos a la práctica criminal, particularmente el familiar.(AU)

Contribuições dos saberes médicos e criminológicos na emergência da psicologia jurídica brasileira / Contributions of medical and criminological knowledge in the emergence of Brazilian legal psychology

Inicialmente destinada como saber auxiliar à prática da justiça, a psicologia jurídica estruturou-se no Brasil a partir do jogo de dupla qualificação médica e judiciária no qual a figura do criminoso passou a prevalecer sobre a apreciação do delito, movimento que uniu práticas disciplinares e jurídicas aos discursos médicos, psiquiátricos e psicológicos. O presente trabalho busca demarcar no percurso histórico de desenvolvimento da psicologia jurídica brasileira suas articulações junto a saberes como a psiquiatria e a criminologia ao longo de um projeto societário disciplinar e normalizador que refletiu no aumento das atividades diagnósticas e avaliativas, ainda hoje as principais atividades endereçadas aos psicólogos jurídicos. Na tentativa de promover reflexões e possibilitar novas análises sobre o tema, são problematizadas neste trabalho as relações entre saber-poder no processo de emergência e estruturação da Psicologia Jurídica no Brasil a partir de certas análises produzidas por Michel Foucault. Trata-se, principalmente, de uma tentativa de se valer de alguns dos elementos conceituais construídos pelo autor como dispositivos para uma análise crítica das relações entre práticas de conhecimento e práticas de poder assumidas pela psicologia jurídica brasileira, problematizando suas regulamentações sociais e urgências políticas enquanto saber e nova tecnologia de poder produzida na modernidade.(AU)

Initially intended as an auxiliary knowledge to the practice of justice, legal psychology was structured in Brazil from the dual medical and judicial qualification game, in which the figure of the criminal person came to prevail over the appreciation of the crime itself, a movement that joined disciplinary and legal practices to the medical, psychiatric and psychological. The present work seeks to demarcate in the historical route of development of psychology and criminology throughout a disciplinary and normalizer corporate project which reflected in the increase of the diagnostic and evaluative activities, still today considered as the main activities addressed to legal psychologists. In attempt to promote reflections and make possible new analyzes on the theme, the relations between knowledge and power in the process of urge and structuration of legal psychology in Brazil are questioned through the perspective of certain analysis made by Michel Foucault. This is mainly an attempt to use some conceptual elements build by the author as tools for a critical analysis of the relations between knowledge competences and power practices assumed by legal psychology in Brazil, as well as questioning its social regimentations and political urgencies as knowledge and new technology of power produced in the modern era.(AU)

La psicología jurídica se estructuró en Brasil a partir del juego de doble calificación médica y judicial en que la figura del criminal pasó a prevalecer sobre la apreciación del delito, movimiento que unió prácticas disciplinarias y jurídicas. El presente trabajo busca demarcar en el recorrido histórico de desarrollo de la psicología jurídica brasileña sus articulaciones junto a saber como la psiquiatría y la criminología a largo de un proyecto societario disciplinario y normalizador que reflejó en el aumento de las actividades diagnósticas y de evaluación, aún hoy las principales actividades dirigidas a los psicólogos jurídicos. En el intento de promover reflexiones y posibilitar nuevos análisis sobre el tema, son problematizadas en este trabajo las relaciones entre saber-poder en el proceso de emergencia y estructuración de la Psicología Jurídica en Brasil a partir de ciertos análisis producidos por Michel Foucault. Se trata, principalmente, de un intento de utilizar algunos de los elementos conceptuales construidos por el autor como dispositivos para un análisis crítico de las relaciones entre prácticas de conocimiento y prácticas de poder asumidas por la psicología jurídica brasileña, problematizando sus regulaciones sociales y urgencias políticas como saber y nueva tecnología de poder producida en la modernidad.(AU)