Accuracy Analysis of Distinguishing the Cooperation Degree during Image Completion Test by Eye Movement Parameters / 法医学杂志

Objective To analyze the differences in accuracy of different eye movement parameters in distinguishing the cooperation and non-cooperation during image completion test of patients with mental disorders caused by craniocerebral trauma. Methods One hundred and forty cases of patients with mental disorders caused by craniocerebral trauma who took psychiatric impairment assessments were collected. The 21 pictures from "image completion" of Wechsler intelligence test were used as stimulating pictures, then divided into cooperation group and non-cooperation group according to binomial forced-choice digit memory test and expert opinions. The eye movement parameters of research subjects during completion of images were obtained by the SMI eye-tracker. The accuracy of eye movement parameters in distinguishing the cooperation or non-cooperation of patients with mental disorders caused by craniocerebral trauma in psychiatric impairment assessments were evaluated by the ROC curve. Results During the process of the image completion test, the area under curve （AUC） value of frequency of blink, frequency of fixation, pupil size, frequency of saccade, latency of saccade, average acceleration of saccade, the average and peak longitudinal velocity of saccade was above 0.5. When it comed to a specific stimulating picture, the AUC value of frequency of blink in looking at a specific stimulating picture could be above 0.8, and the AUC value of X axis diameter of pupil size could be above 0.7. Conclusion The accuracy of eye movement parameters in distinguishing the cooperation or disguise of patients with mental disorders caused by craniocerebral trauma is related with the stimulating picture. The accuracy of frequency of blink in distinguishing cooperation and non-cooperation is better than that of other eye movement parameters.

Working Memory of Patients with Mild Cognitive Impairment due to Brain Trauma Based on fNIRS / 法医学杂志

Objective To discuss the activation characteristics of the prefrontal cortex of people with mild cognitive impairment （MCI） due to brain trauma during working memory tasks. Methods The psychological experiment design software E-prime was used and N-back paradigm was adopted as working memory task. Functional near-infrared spectroscopy （fNIRS） was used to detect changes in cortical oxygenated hemoglobin concentrations of 22 channels within the prefrontal lobe of 24 people with MCI due to brain trauma （study group） and 27 healthy volunteers （control group） with matching gender and age. Behavioral data, such as the number of keystroke errors and reaction time, were recorded simultaneously. Independent samples t test and non-parametric test were used to compare the mean value of oxygenated hemoglobin concentration change, the number of key errors and the mean value of reaction time of the two groups in each task. Results （1） The differences in the number of errors and reaction time between the two groups in 1-back and 2-back tasks had statistical significance （P<0.05）.The main effects of task load and group were both significant （task F=14.11, P=0.001 1; group F=10.39, P=0.001 5）. （2） During the 1-back task, the differences in oxygenated hemoglobin concentration changes of the 22 channels between the two groups had no statistical significance （P>0.05）. During the 2-back task, the differences in oxygenated hemoglobin concentration changes of the two groups in channel 2, 3, 7, 9, 10, 11, 14, 15, 18, 19, 21 and 22 had statistical significance （P<0.05）. （3） In the 1-back task, the left frontal pole and dorsolateral prefrontal area in both groups were activated. In the 2-back task, the activation areas of the control group were the left frontal pole area and the left dorsolateral prefrontal area, while that of the study group almost covered most of the left and right frontal pole areas, which were scattered and the right area was activated, too. Conclusion Patients with MCI due to brain trauma have obvious working memory impairment, and during the 2-back working memory task, the activation of the prefrontal lobe decreased, but the activation range was wider.

Application of Mismatch Negative in Evaluation of Severity of Mental Disorders due to Traumatic Brain Injury / 法医学杂志

Objective To explore the applied value of mismatch negative （MMN） in evaluation of severity of mental disorders due to traumatic brain injury. Methods Thirty-five patients（case group） that conform to the diagnostic criteria of organic （traumatic brain injury） mental disorder in ICD-10 Classification of Mental and Behavioural Disorders criteria were selected. Twenty-four healthy subjects （normal control group） that matched the case group in terms of gender, age composition ratio and educational level were selected. All subjects were evaluated by Activity of Daily Living Scale （ADL） and Social Disability Screening Schedule （SDSS） and then examined by Event-Related Potential （ERP）. A statistical analysis of the data was made by SPSS 22.0 software. Results The 32 patients and 24 normal control subjects completed the study. The scores of ADL and SDSS were significantly higher in the case group than in the normal control group （P<0.05）. The latency of Fz, FCz, Cz and Pz in the case group was significantly longer than that in the normal control group （P<0.05）. In the case group, the latency of Fz, FCz, Cz and Pz was positively correlated with the scores of ADL and SDSS （P<0.05）. The equation can be well fitted with the scores of ADL and SDSS. The latency and amplitude of Fz, FCz, Cz and Pz were used as concomitant variables and whether or not the subjects had mental disorders due to traumatic brain injury as dependent variables. Conclusion The latency of MMN can be used as an indicator in potential evaluation of the severity of mental disorders due to traumatic brain injury, which means that the longer the latency of MMN is, the more severe mental disorders due to traumatic brain injury may be. The combined application of ADL, SDSS and MMN can be an objective indicator in preliminary judgment of mental disorders due to traumatic brain injury.

Application of Activities of Daily Living Scale in Mild Psychiatric Impairment As-sessment / 法医学杂志

Objective To explore the application of activities of daily living(ADL)scale in mild psy-chiatric impairment assessment under the guideline of Classification of Human Body Disability Caused by Injury. Methods A total of 124 subjects with organic mental disorders and mild psychiatric impair-ments(levels 7 to 10), and 106 healthy controls were included in. All participants were assessed by the ADL scale, physical self-maintenance scale(PSMS)and instrumental activities of daily living(IADL) scale. The difference between the scores of control group and study group, and the relationship of im-pairment level and the scores were compared, and the threshold value was determined according to the ROC curve. Results The total scores of ADL, IADL and PSMS were significantly different between the control group and the study group(P<0.05). The scores of ADL,IADL,PSMS were significantly different among the impairment levels(P<0.05), which showed a relativity with impairment level. The scores of ADL corresponding to levels 10, 9, 8 and 7 were 14-17, 18-23, 24-29 and 30-34, respectively, which showed a good correlation between the conclusion according to the scale and the expert's opinion(k=0.914, P<0.05). Conclusion The score of ADL was significantly related to mild psychiatric impairment, and the higher ADL score represents the more severe disability, which can be used as a reference index for preliminarily judging the level of mild psychiatric impairment.

Eye Movement Characteristics of Cooperation Degree during Image Completion Test in Psychiatric Impairment Assessment / 法医学杂志

OBJECTIVES@#To explore the difference of eye movement characteristics between uncooperative and cooperative subjects with mental disorder after cerebral trauma.@*METHODS@#Thirty-nine subjects which needed psychiatric impairment assessment were selected. According to the binomial forced-choice digit memory test （BFDMT）, all subjects were divided into cooperative and uncooperative groups. The subjects were asked to take the image completion test from Wechsler adult intelligence scale. Meanwhile, the data of eye movement track, fixation, saccade, pupil and blink were recorded by the track system of eye movement.@*RESULTS@#There were significantly differences （P<0.05） in the data of saccade between cooperative （10 cases） and uncooperative groups （29 cases）. The frequency, time, amplitude, acceleration of saccadic in uncooperative group were significantly higher than cooperation group. The saccade latencies of cooperation group increased more than uncooperative group. There was a significant difference （P<0.05） in total discrete distance, average distance and total time of fixation between two groups, while the average duration time, number and frequency of fixation had no significantly difference （P>0.05） between two groups. And the blink frequency of cooperation group was higher than uncooperative group.@*CONCLUSIONS@#Eye movement can be an objective index for the primary judgment of cooperation level.

Personality Change due to Brain Trauma Caused by Traffic Accidents and Its Assessment of Psychiatric Impairment / 法医学杂志

OBJECTIVE@#To explore the main performance of personality change in people with mild psychiatric impairments which due to the brain trauma caused by traffic accidents and its value in assessment of psychiatric impairment.@*METHODS@#The condition of personality change of patients with traumatic brain injury caused by traffic accident was evaluated by the Scale of Personality Change Post-traumatic Brain Injury (SPCPTBI). Furthermore, the correlation between the personality change and the degrees of traumatic brain injury and psychiatric impairment were explored. Results In 271 samples, 239 (88.2%) with personality changes. Among these 239 samples, 178 (65.7%), 46 (17.0%), 15 (5.5%) with mild, moderate and severe personality changes, respectively. The ratio based on the extent of personality changes to the degree of brain trauma was not significant (P > 0.05), but the total score difference between the groups was significant (P < 0.05). There was no statistical significance between the medium and high severity brain trauma groups. The higher degree of personality changes, the higher rank of mental disabilities. The total score difference of the scale of personality change among the different mild psychiatric impairment group was significant (P<0.05). The difference between other psychiatric impairment levels had statistical significance (P < 0.05) except level 7 and 8.@*CONCLUSION@#The occurrence of personality change due to traumatic brain injury caused by traffic accident was high. Correlations exist between the personality change and the degree of psychiatric impairment. Personality change due to brain trauma caused by traffic accident can be assessed effectively by means of SPCPTBI, and the correlation between the total score and the extent of traumatic brain injury can be found.

Relevance between writing characteristic and therapeutic effect in schizophrenia / 法医学杂志

OBJECTIVE@#To explore the relevance between writing characteristic and therapeutic effect in schizophrenia and to discuss the influence of aggressive behavior on writing characteristic.@*METHODS@#Recoding the casual and fixed writing in admission, one week, two weeks, four weeks, eight weeks after treatment and rating Positive and Negative Syndrome Scale (PANSS) and Modified Overt Aggression Scale (MOAS). Choosing two characteristics, "relationship between font and grid lines" and "having big strokes or not", and comparing before and after treatment.@*RESULTS@#Eight weeks after treatment, the score of PANSS decreased. The condition of patients and the writing characteristic improved as well. The differences of writing characteristics were statistically significant in patients with aggressive behavior before and after treatment (P < 0.05).@*CONCLUSION@#The writing characteristic has relation with therapeutic effects and improved with therapeutic effects in aggressive patients.

Disability identification for cases with clinical diagnosis of diffuse axonal injury due to traffic accidents: a study of 89 cases / 法医学杂志

OBJECTIVE@#To study the disability identification for cases with clinical diagnosis of diffuse axonal injury (DAI) due to traffic accidents, and to explore the possible effects of DAI on identification results.@*METHODS@#Five hundred and fifty-six cases of cerebral injury due to traffic accidents were collected, including 467 cases diagnosed with cerebral contusion or laceration and 89 cases diagnosed with DAI. The identification results of different groups with diagnosis of DAI diagnosis, diagnosis of DAI with cerebral contusion (laceration), and diagnosis of cerebral contusion or laceration without DAI were compared and statistically analyzed, based on the results of CT and MRI re-review.@*RESULTS@#The disability identification levels in DAI group (20 cases), DAI group (69 cases) with cerebral contusion (laceration) and DAI group (467 cases) not complicated by cerebral contusion (laceration) were 7.72 +/- 1.09, 7.78 +/- 1.11, and 8.86 +/- 0.66, respectively. The disability levels of the two groups diagnosed with DAI were higher than those of the group without DAI diagnosis (P < 0.05).@*CONCLUSION@#Patients with DAI diagnosis might have more severe cerebral injury. In the identification process, one should pay attention to the possible missed diagnosis and misdiagnosis, and meanwhile avoid relying on those evidences provided only by CT and MRI.

Applicability of capacity of sexual self-defense assessment scale in psychiatric patients without mental retardation / 法医学杂志

OBJECTIVE@#To explore the applicability of Capacity of Sexual Self-defense Assessment Scale (CSSAS) in psychiatric patients without mental retardation.@*METHODS@#Eighty-seven cases required for assessment of the capacity of sexual self-defense were collected and evaluated by trained professionals according to CSSAS, and the results were compared to the experts' opinions.@*RESULTS@#The scores of three grades of capacity of sexual self-defense (none, limited and whole) were 5.97 +/- 5.83, 32.22 +/- 10.15 and 61.60 +/- 13.02, respectively, which were statistically significant among them (P < 0.01). The correlation coefficients between items and total score were 0.59 to 0.91, the Cronbach's alpha value was 0.96, the spilt half Cronbach's alpha value were 0.94 and 0.91, respectively, and the relation coefficient between them was 0.94. According to the original cut off scores, the Kappa value between scale results and experts' opinions was 0.32 (P < 0.01). By redefining the cut off scores, the Kappa value was improved to 0.84 (P < 0.01). Two factors were extracted by means of the factor analysis. The explanation rates of variance were 46.15% and 28.93%, respectively. The accuracy of retrospective cumulative square was 94.30%.@*CONCLUSION@#The CSSAS could be applied in the psychiatric expertise of the capacity of sexual self-defense in psychiatric patients without mental retardation; however, the cut off scores and the factor weight should be redefined.

Development of competency to stand trial rating scale in offenders with mental disorders / 法医学杂志

OBJECTIVE@#According with Chinese legal system, to develop a competency to stand trial rating scale in offenders with mental disorders.@*METHODS@#Proceeding from the juristical elements, 15 items were extracted and formulated a preliminary instrument named the competency to stand trial rating scale in offenders with mental disorders. The item analysis included six aspects, which were critical ratio, item-total correlation, corrected item-total correlation, alpha value if item deleted, communalities of items, and factor loading. The Logistic regression equation and cut-off score of ROC curve were used to explore the diagnostic efficiency.@*RESULTS@#The data of critical ratio of extreme group were 18.390-46.763; item-total correlation, 0.639-0.952; corrected item-total correlation, 0.582-0.944; communalities of items, 0.377-0.916; and factor loadings, 0.614-0.957. Seven items were included in the regression equation and the accuracy of back substitution test was 96.0%. The score of 33 was ascertained as the cut-off score by ROC fitting curve, the overlapping ratio compared with the expertise was 95.8%. The sensibility and the specificity were 0.938 and 0.966, respectively, while the positive and negative likelihood ratios were 27.67 and 0.06, respectively.@*CONCLUSION@#With all items satisfied the requirement of homogeneity test, the rating scale has a reasonable construct and excellent diagnostic efficiency.

Progress in standard assessment on competency to stand trial of mentally disordered offenders / 法医学杂志

Competency to stand trial relates directly to legal rights of the appraised individual as well as whether criminal procedure can be carried out smoothly. Foreign scholars have conducted a large number of theoretical researches, and developed a series of standardized evaluation tools. However, the assessment on competency to stand trial has mainly focused on medical criteria in China for a long time, and most cases were judged by forensic psychiatrists' experience. Recently, Chinese scholars have started the initial research on standardized evaluation. This paper reviews the notion of competency to stand trial, the evaluation criteria, and the assessment tools domestically and abroad. The main focus is on foreign assessment tools, which included three categories. First category includes checklist, self-report questionnaires and sentence-completion tasks. Second category is the interview-based instruments without criterion-based scoring. Last category is the interview-based instruments with criterion-based scoring. This literature may be helpful for further research and standardization on assessment tools of competency to stand trial of mentally disordered offenders.

Reliability of the Violence Risk Scale of Chinese version / 法医学杂志

OBJECTIVE@#To introduce and revise the Violence Risk Scale (VRS) for assessing violence risk and risk change, and to examine the reliability of Violence Risk Scale of Chinese version(VRS-C).@*METHODS@#The original English version of the VRS was translated into Chinese according to established translation procedures. To examine the scorer reliability the 14 cases assessed by 3 assessors separately. One hundred and twenty-five patients with mental disorders from 3 different institutions in Sichuan province (Refined Control Ward in Ankang Hospital, Department of Forensic Psychiatry, Institute of Forensic Science and Mental Health Center of West China Hospital) were collected to examine the reliability of VRS-C.@*RESULTS@#The results showed moderately good scale reliability of the VRS-C, with 0.80 of ICC for scorer reliability. All items have significant consistence with Cronbach's alpha coefficient as 0.921, split-half reliability as 0.906 and item total correlation as 0.246-0.849.@*CONCLUSION@#The reliability of the VRS-C version is acceptable.

Correlation between the eicosapentaenoic acid, docosahexaenoic acid and the aggressive behavior in mice / 法医学杂志

OBJECTIVE@#To explore the correlation between the eicosapentaenoic acid(EPA), docosahexaenoic acid (DHA) and the aggressive behavior in mice.@*METHODS@#Seventy-two male Kunming mice were divided into control group, fish oil group, simvastatin group and aggressive reference group randomly. The control group, fish oil group and simvastatin group were given normal saline, fish oil and simvastatin by irrigation respectively for 3 months consecutively, each mouse was raised isolatedly. The latent period of assault, the frequencies of tail swing and assault, and the cumulative time of assault were recorded at the beginning and the end of the intervention. Finally, the EPA and DHA in brain were analyzed by gas chromatography-mass spectrometry (GC-MS). The aggressive reference group was raised without intervention and was evaluated as aggressive reference only.@*RESULTS@#(1) Before intervention, the latent period of assault, the frequencies of tail swing, the frequencies of assault, and the cumulative time of assault were not significantly different from each other group. After intervention, the differences were significant (P<0.05). (2) After the intervention, the content of EPA and DHA in mice brain was the most in the fish oil group, and the least in the simvastatin group. (3) The content of EPA was negatively related with the four indexes (P<0.05) before and after the intervention. The content of DHA was negatively related with the frequencies of tail swing and assault (P<0.05).@*CONCLUSION@#There is a correlation between the EPA, DHA and aggressive behavior in mice under stress.

Progress on relationship between omega-3 polyunsaturated fatty acids and violent-aggressive behavior / 法医学杂志

The relationship between omega-3 polyunsaturated fatty acids (PUFAs) and violent-aggressive behavior has been payed attention since 1980s. Their correlation was explored by many epidemiological investigations, and the effect of PUFAs on prevention or reduction of violent-aggressive behavior in different groups were also affirmed by some intervention studies. This article summarized the previous studies and reviewed the history of epidemiological or intervention studies on PUFAs and its relationship with violent-aggressive behavior. It also presented the possible influencing factors in these studies and possible mechanisms.

Preliminary study on civil capacity rating scale for mental disabled patients / 法医学杂志

OBJECTIVE@#To create civil capacity rating scale for mentally disabled patients, and explore its feasibility during the forensic psychiatric expertise.@*METHODS@#The civil capacity-related items were determined after discussion and consultation. The civil capacity rating scale for mentally disabled patients was established and the manual was created according to the logistic sequence of the assessment. The rating scale was used during the civil assessment in four institutes.@*RESULTS@#There were 14 items in civil capacity rating scale for mentally disabled patients. Two hundred and two subjects were recruited and divided into three groups according to the experts' opinion on their civil capacities: full civil capacity, partial civil capacity and no civil capacity. The mean score of the three groups were 2.32 +/- 2.45, 11.62 +/- 4.01 and 25.02 +/- 3.90, respectively, and there was statistical differences among the groups. The Cronbach alpha of the rating scale was 0.9724, and during the split-reliability test, the two-splited part of the rating scale were highly correlated (r = 0.9729, P = 0.000). The Spearman correlative coefficient between each item and the score of the rating scale was from 0.643 to 0.882 (P = 0.000). There was good correlation between the conclusion according to the rating scale and the experts' opinion (kappa = 0.841, P = 0.000). When the discriminate analysis was used, 7 items were included into the discrimination equation, and 92.6% subjects were identified as the correct groups using the equation.@*CONCLUSION@#There is satisfied reliability and validity on civil capacity rating scale for mentally disabled patients. The rating scale can be used as effective tools to grade their civil capacity during the forensic expertise.

The application of criminal responsibility rating scale for suspects with mental retardation / 法医学杂志

OBJECTIVE@#To explore the feasibility of the criminal responsibility rating scale for suspects with mental retardation.@*METHODS@#Ninety six suspects with mental retardation were evaluated by trained professionals according to the scale, and the results were compared to the expert's opinion.@*RESULTS@#The scores of three groups (no, diminished, and responsibility group) were 12.25 +/- 2.06, 28.62 +/- 4.57, 44.41 +/- 5.17 respectively and were significant different among them. All items had statistical correlation with the total score of the scale. Five factors were extracted by means of the factor analysis and they could explain 70.919% of the variation. The accuracy of retrospective cumulative square was 92.7%.@*CONCLUSION@#The Criminal Responsibility Rating Scale has good reliability and validity, and can be used as a reference in assessment of criminal responsibility.

Progress on neuropsychology and event-related potentials in patients with brain trauma / 法医学杂志

With the development of information technology, as one of the research frontiers in neurophysiology, event-related potentials (ERP) is concerned increasingly by international scholars, which provides a feasible and objective method for exploring cognitive function. There are many advances in neuropsychology due to new assessment tool for the last years. The basic theories in the field of ERP and neuropsychology were reviewed in this article. The research and development in evaluating cognitive function of patients with syndrome after brain trauma were focused in this review, and the perspectives for the future research of ERP was also explored.

The application of diminished criminal responsibility rating scale to mental retardation offenders / 法医学杂志

OBJECTIVE@#To explore the application of Diminished Criminal Responsibility Rating Scale (DCRRS) to mental retardation offenders.@*METHODS@#The DCRRS was used to 121 cases of mental retardation offenders who were divided into three groups according to the degree of their diminished criminal responsibility.@*RESULTS@#There were significant differences in rating score among the three groups (mild group 22.12+/-4.69, moderate group 25.50+/-5.48, major group 27.59+/-5.69), and 17 items had good correlation with the total score of the scale with the correlation coefficient from 0.289 to 0.665. Six factors were extracted by the factor analysis, and 69.392% variation could be explained.@*CONCLUSION@#The DCRRS has rational items, its total score could show the difference among the three degree diminished criminal responsibility of mental retardation offenders.

Advanced investigation of testamentary capacity of the mentally disordered / 法医学杂志

Testamentary capacity is one of the civil competences, it means that a natural person enjoys the capacity or qualification to establish testament and deal with his property. Recently, the cases of testamentary capacity assessment of the mentally disordered are increasing. This article firstly introduces the concepts of the testament as well as the testamentary capacity, and then summarizes the assessment standard of the testamentary capacity, by using the Banks v. Goodfellow case as a basis to make the standard criteria including: the understanding of the nature of a will and codicil, the knowledge of the general extent of one's assets, the knowledge of the natural object of one's bounty, the understanding of the impact of the distribution of the assets of the estate, and the absence of a delusion specifically affecting the distribution of the estate. The impact factors of the testamentary capacity, including dementia, mood disorder, schizophrenia, alcohol, drug, and undue influence, etc., are summarized. Lastly, the related assessment tools such as the Mini-Mental State Examination, the Clock-Drawing Test, and the Testament Definition Scale are introduced briefly.

Civil competence assessment of the mental disorders involved in contract dispute / 法医学杂志

OBJECTIVE@#To search the criteria for evaluating the civil competence of the mental disorders involved in contract dispute.@*METHODS@#Data on the interviewee's mental status and the forensic expertise were collected retrospectively. And 6 indexes were selected and graded: awareness of situation, factual understanding of issues, appreciation of likely consequences, rational manipulation of information, functioning in one's own environment and communication of choice. All of the data were analyzed by SPSS.@*RESULTS@#Fifty six cases were included and interviewee's civil competence was graded to three levels: full civil competence, diminished civil competence, and no civil competence. These cases included two types of contract: the real estate related contract (38 cases) and the labor related contract (14 cases). All of the 6 indexes were well correlated to the forensic expertise. The related coefficient was from 0.703 to 0.834, and the interrelated coefficient of the 6 items was also high, from 0.712 to 0.877.@*CONCLUSION@#It is feasible to divide the civil competence of the mental disorders into three grades. As the basis, these 6 indexes mentioned above are representative and can be applied in further standardized and quantified assessment of civil competence.