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.

El uso de instrumentos de evaluación de riesgo de violencia en Argentina y Chile / The use of violence risk assessment instruments in Argentina and Chile / O uso dos instrumentos da avaliação do risco da violência na Argentina e no Chile

Introducción: En las últimas décadas hubo importantes avances científicos en la sistematización de la evaluación del riesgo de violencia, pero esas contribuciones no se implementan de manera rápida ni uniforme en la práctica latinoamericana. Objetivos: Describir qué instrumentos de evaluación de riesgo de violencia se utilizan en Chile y Argentina, y qué características tiene esa práctica profesional. Material y método: Se realizó una encuesta a través de la web, a profesionales relacionados con la salud mental registrados en listas nacionales e internacionales de 17 países, entre septiembre y diciembre del 2012. En el estudio se informan resultados de 46 respondientes de Chile y Argentina. Resultados: El 78% de los psiquiatras, el 93% de los psicólogos y el 100% de los trabajadores sociales utilizaron instrumentos para ERV; la amplia mayoría los consideró relativamente útiles. Los instrumentos más utilizados fueron HCR-20, PCL-R y PCL-SV.

Introdução: Nas últimas décadas houve avanços científicos importantes na sistematização da avaliação do risco da violência, mas aquelas contribuições não são executadas rapidamente nem uniformemente na prática latino-americana. Objetivos: Descrever que instrumentos da avaliação do risco da violência são usados no Chile e na Argentina, e que características tem essa prática profissional. Material e método: Uma pesquisa foi feita através da Web, aos profissionais relacionados à saúde mental registrados nas listas nacionais e internacionais de 17 países, entre setembro e dezembro do 2012. No estudo os resultados de 46 respondentes do Chile e da Argentina são informados. Resultados: 78% dos psiquiatra, 93% dos psicólogos e o 100% dos trabalhadores sociais usaram instrumentos para ERV; a ampla maioria os considerou relativamente úteis. Os instrumentos mais usados foram HCR-20, PCL-R e PCL-SV.

Introduction: The last decades revealed important scientific advances in the systemization of violence risk assessment; nevertheless, the implementation in practice of these contributions have neither been fast nor uniform in Latin America. Objectives: The article is aimed at describing the instruments for violence risk assessment used in Chile and Argentina and the features of this professional practice. Material and method: A web survey was carried out among mental health-related professionals registered in the national and international lists of 17 countries between September and December 2012. The results obtained from 46 respondents from Chile and Argentina are reported in this study: 78% of the psychiatrists, 93% of the psychologists and 100% of the social workers involved have employed violence risk assessment (VRA) instruments deemed relatively useful by a wide majority, being HCR-20, PCL-R and PCL-SV the most commonly used.

Aproximación diagnóstica de psicopatía mediante instrumento autoinformado / A diagnose approach to psychopathy using a self-report instrument / Aproximação diagnóstica da psicopatia por meio do instrumento autoinformado

Introducción: Dada la relevancia clínica y social que tiene la psicopatía, resulta útil contar con instrumentos autoinformados para la aproximación diagnóstica a la psicopatía. Objetivos: Evaluar la congruencia interna y la validez convergente del Self Report of Psychopathy-Short Form. Material y métodos: Se evaluaron 208 personas condenadas, alojadas en el Centro de Cumplimiento Penal de la Provincia de Los Andes, Chile. Se utilizaron el SRP-III-SF, el PCL-R y la HCR-20. Resultados: La distribución de valores del SRP-III-SF tuvo una media de 61,6 y fue normal. El Coeficiente de Alfa de Cronbach para el total fue 0,8 y para los factores 1, 2, 3 y 4 fue 0,7, 0, 4, 0,7 y 0,5, respectivamente. La correlación del SRP-III-SF con el PCL-R fue 0,4 (p = 0,01) y con HCR 20, 0,5 (p < 0,001). El riesgo de diagnóstico de psicopatía con el PCL-R aumentó en forma lineal para cada cuartil de la distribución del SRP-SF. El área bajo la curva ROC fue 0,66 (p = 0,05; 95% IC 0,5; 0,8).

Introduction: Given the clinical and social relevance of psychopathy, it is desirable to have self-report instruments for a proper diagnostic approach. Objectives: Assess the internal congruence and convergent validity of the Self Report of Psychopathy Scale III-Short Form. Material and Methods: 208 convicts housed at the “Centro de Cumplimiento Penal” detention center in the Province of Los Andes, Chile, were evaluated using the SRP-III-SF, PCL-R, and HCR-20 schemes. Results: the SRP-III-SF distribution was normal, with a mean of 61.6. The Cronbach’s Alpha Coefficient for the total was 0.8, and 0.7, 0.4, 0.7 and 0.5 for the 1, 2, 3, and 4 factors respectively, while the correlations of SRP-III-SF with PCL-R and HCR 20 were, respectively, 0.4 (p = 0.01) and 0.5 (p < 0,001). The scores of the PCL-R diagnosed psychopathy were linearly higher for each quartile of the SRP-SF distribution. The area under the ROC curve was 0.66 (p = 0.05; 95% IC 0.5; 0.8).

Introdução: Dada a relevância clínica e social que tem a psicopatia, é útil contar com instrumentos autoinformados para a aproximação diagnóstica à psicopatia. Objetivos: Avaliar a congruência interna e a validez convergente do Self Report of Psychopathy-Short Form. Material e métodos: Avaliaram-se 208 pessoas condenadas, alojadas no Centro de Cumprimento Penal da Província dos Andes, Chile. SRP-III-SF, PCL-R e HCR-20 foram usados. Resultados: A distribuição dos valores do SRP-III-SF teve uma média de 61.6 e foi normal. O Coeficiente do Alfa de Cronbach para o total foi 0.8 e para os fatores 1, 2, 3 e 4 foi 0.7, 0.4, 0.7 e 0.5, respectivamente. A correlação do SRP-III-SF com PCL-R foi 0.4 (p = 0.01) e com HCR 20, 0.5 (p < 0.001). O risco do diagnóstico de psicopatia com o PCL-R aumentou em forma linear para cada quartil da distribuição do SRP-SF. A área sob a curva ROC foi 0.66 (p = 0.05; 95% IC 0.5; 0.8).

Statistical prediction methods in violence risk assessment and its application / 法医学杂志

It is an urgent global problem how to improve the violence risk assessment. As a necessary part of risk assessment, statistical methods have remarkable impacts and effects. In this study, the predicted methods in violence risk assessment from the point of statistics are reviewed. The application of Logistic regression as the sample of multivariate statistical model, decision tree model as the sample of data mining technique, and neural networks model as the sample of artificial intelligence technology are all reviewed. This study provides data in order to contribute the further research of violence risk assessment.

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.

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.

The investigation of event-related brain potentials in malingered neurocognitive deficit / 法医学杂志

In the fields of judicial psychiatric identification, about 40%-60% of the people maybe exaggerate their injury for personal profit. Though some psychological tests are effective in identification, they are limited in cunning liars. This article summarizes previous experimental mode, results and effects of event-related potential (ERP) in detecting cognitive malingering. ERP technology can be highly sensitive and specific. It is a kind of objective physiological index and is a promising technology in detecting cognitive malingering.

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.

Reliability of the Brazilian version of HCR-20 Assessing Risk for Violence / Confiabilidade da versão brasileira do HCR-20 Assessing Risk for Violence

OBJECTIVE: Assessing risk for violence is a complex task often based on not objective or structured clinical evaluations. HCR-20 Assessing Risk for Violence has been used in several countries to increase the accuracy of this exam. The purpose of this study was to inform on central aspects of this instrument, as well as the results of the reliability assessment of the HCR-20 Assessing Risk for Violence in a Brazilian inpatient criminal population. METHOD: Two examiners independently assessed a random sample of 30 patients that were under criminal commitment at the Mauricio Cardoso Forensic Psychiatric Institute RESULTS: Mean consensus values means were as follows: Historical = 13.1; Clinical = 4.8 and Risk management = 5.8. The value of the Intraclass Correlation Coefficient for the score of subscale Historical was 0.97, for subscale Clinical it was 0.94, and for subscale Risk management, 0.96. As to the individual items of the HCR-20 Assessing Risk for Violence, the result of the Intraclass Correlation Coefficient was good to excellent (mean = 0.97; interval, from 0.60 to 0.99). CONCLUSION: The interrater reliability of the Brazilian version of the HCR-20 Assessing Risk for Violence scale was similar to the results of studies in other countries.

OBJETIVO: A avaliação de risco de violência é uma tarefa complexa baseada muitas vezes em critérios clínicos pouco objetivos e estruturados. O HCR-20 Assessing Risk for Violence tem sido usado em diversos países para aumentar a precisão deste exame. O presente estudo tem como objetivo informar aspectos nucleares deste instrumento, bem como os resultados da avaliação da confiabilidade do HCR-20 Assessing Risk for Violence em uma amostra da população manicomial brasileira. MÉTODO: Dois examinadores avaliaram independentemente uma amostra de 30 pacientes selecionada aleatoriamente da população em cumprimento de Medida de Segurança no Instituto Psiquiátrico Forense Maurício Cardoso. RESULTADOS: Os valores das médias de consenso entre os entrevistadores foram os seguintes: Histórica = 13,1; Clínica = 4,8 e Manejo de risco = 5,8. O valor do Coeficiente de Correlação Interno para a pontuação da subescala Histórica foi 0,97; para a pontuação da subescala Clínica foi 0,94; e para a subescala Manejo de risco foi 0,96. Quanto aos itens individuais do HCR-20 Assessing Risk for Violence, o resultado do Coeficiente de Correlação Interno foi de bom a excelente (média = 0,97; intervalo de 0,60 a 0,99). CONCLUSÃO: A confiabilidade entre os avaliadores da versão brasileira da escala HCR-20 Assessing Risk for Violence foi similar aos resultados de estudos em outros países.

Psychological autopsy and its limitation in application / 法医学杂志

The suicide were analyzed depending only on the death scene and cadaver features but not on the psychological autopsy (PA) that also enables the determination of the manner of death in China for a long time. There are significant differences between PA and the traditional risk assessment of suicide. The goals of PA are to find out the features of individuality, the patterns of behavior and the possible motives of suicide. The methods of PA involve investigating, collecting and analyzing all related information of the deceased. There are many limitations of PA in application mainly due to the lack of the standard procedures. Although an improved procedure has recently developed by Berman, many problems need to be solved before the actual application of PA in China.

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.

Homicídio seguido de suicídio: relato de caso / Homicide followed by suicide: case report

Objetivo: Examinar o fenômeno clínico de homicídio seguido de suicídio (HS) a partir de um caso no qual o desfecho de suicídio não ocorreu por motivos alheios à vontade e às ações do sujeito. Descrição do caso: Trata-se do caso de um homem que matou sua namorada por ciúmes, por ocasião do término do relacionamento entre ambos, tentando, a seguir, o suicídio. No presente artigo, é dada especial ênfase aos aspectos forenses do caso, avaliado para fins de determinação de responsabilidade penal e acompanhado no Instituto Psiquiátrico Forense Dr. Maurício Cardoso, Porto Alegre (RS). Comentários: Ressalta-se que, ao se modificar o desfecho de um caso típico de HS, por não ter se consumado o suicídio do homicida, dois aspectos assumem relevância: as consequências legais a serem enfrentadas pelo sujeito e o manejo do impacto psíquico no sobrevivente. Do ponto de vista da prevenção, o conhecimento do fenômeno HS e dos fatores descritos como associados a ele justificaria uma constante atenção ao tema por parte dos profissionais de saúde mental. O presente relato foi autorizado pelo paciente através de termo de consentimento livre e esclarecido.

Objective: The clinical phenomenon of homicide followed by suicide (HS) is examined through a case in which suicide was avoided despite the individual’s will and actions. Case description: A man killed his girlfriend at the end of the relationship because of jealousy. After that, he attempted suicide. Special emphasis is given to the forensic aspects of the case, which has been assessed to determinate the individual’s criminal responsibility and has been followed up at the Forensic Psychiatric Institute Dr. Maurício Cardoso, in Porto Alegre, state of Rio Grande do Sul, Brazil. Comments: When the outcome of a typical case of HS is modified and the suicide of the murderer is not accomplished, two aspects become important: the legal consequences to be faced by the murderer and the management of the psychological impact on the survivor. Regarding prevention, the knowledge of HS and its associated factors require constant attention by mental health professionals. This report was authorized by the patient by means of informed consent.

El BEST-Index: un instrumento para la valoración de la peligrosidad y las habilidades prácticas en pacientes psiquiátricos / BEST-Index: an instrument for evaluating the dangerousness and practic ability in psychiatry patients

El objeto de este estudio fue ampliar la base empírica de un instrumento para la valoración de la peligrosidad y las habilidades sociales (Behavioural Status índex [BEST-Index]) y explorar su utilidad en la práctica psiquiátrica. La muestra se compuso de N = 86 pacientes internados en unidades psiquiátricas forenses. Los pacientes fueron evaluados en tres oportunidades en intervalos de nueve meses con el BEST-Index, la Escala de Calificación de la Psicopatía Revisada (Psychopathy Check List Revised [PCL-R]) y la escala HCR-20 (Historical-Clinical-Risk Management-20). Resultados: El BEST-Index posee una confiabilidad interjueces adecuada; las escalas del BEST-Index exhiben correlaciones significativas con los instrumentos estadísticos PCL-R y HCR-20. Además, el BEST-Index permite valorar cambios conductuales relevantes en el curso del tratamiento

The aim of this study was to introduce a unified approach to assessment of social risk and related social behaviours in offender groups using the Behavioural Status Index (BEST-Index); and to explore its clinical utility for the forensic psychiatric field. Using an initial sample of N=86 forensic psychiatric patients, the BEST-Index, the Psychopathy Checklist Revised [PCL-R] and the scale HCR-20 (Historical-Clinical-Risk Management-20) were applied three times in intervals of nine months. Results: The BEST-Index has satisfactory inter rater reliability; the data suggest good convergent validity of the BEST-Index scales and the actuarial instruments (HCR-20, PCL-R); the BEST-Index also allows for monitoring behavioural change over the treatment period

The assessment of criminal responsibility of schizophrenic rape offenders / 法医学杂志

OBJECTIVE@#To explore potential application of Diminished Criminal Responsibility Rating Scale (DCRRS) on rape offenders.@*METHODS@#The DCRRS was used retrospectively to study 77 cases of rape offenders. They were divided into three groups according to the degree of diminished criminal responsibility.@*RESULTS@#There were significant differences in rating scores among three groups (mild group 21.32+/-5.56, moderate group 25.92+/-5.19, and major group 29.54+/-4.62), and 16 of 18 items showed good correlation with the total scores of the scale (r=0.256 to 0.611), 7 factors were extracted by the factor analysis and their cumulative squared loadings was 75.784%.@*CONCLUSION@#The DCRRS is valid and reliable in a in assessment of criminal responsibility schizophrenic rape offenders.

Evaluation on social function in cases involving sexual assault of patients with mental retardation / 法医学杂志

OBJECTIVE@#To explore social function in assessment of self-defense capability of patients with mental retardation against sexual assault.@*METHODS@#The data of 125 sexual assault victims with mental retardation were collected according to our forensic psychiatry assessment criteria. Mental retardation was rated with WAIS-RC, GAF, and the rating scale of the intelligence disability.@*RESULTS@#There were significant differences in occupation, marital status, education, knowledge about sex, and history of pregnancy among the patients with different levels of self-defense capability. The kappa values of the rating scale score of the intelligence disability, GAF, and IQ were 0.710, 0.661, and 0.494; the kappa values of that and self-defense capability were 0.538, 0.472, and 0.316 respectively.@*CONCLUSION@#The level of social function is very important in the assessment of self-defense capability in patients with mental retardation.

Analysis of intelligence in criminals with no psychosis diagnosed with forensic psychiatry / 法医学杂志

OBJECTIVE@#To study the intelligence of criminals with no psychosis diagnosed with forensic psychiatry.@*METHODS@#The intelligence test results in 88 criminal cases with no psychosis and in 89 criminal cases with schizophrenia were compared.@*RESULTS@#There were no significant statistical differences between two groups with respect to their sex, age, education, occupation, marital status, and criminal type. The average intelligence quotient (IQ) of no psychosis group was significantly higher than that of the schizophrenic group, but was significantly lower than the normal. There was no significant statistical difference between the subgroups claiming as either suffering or denying psychosis.@*CONCLUSION@#There is a mild impairment in the intelligence in no psychosis group.

Application of contribute degree in forensic mental trauma assessments / 法医学杂志

It is very difficult to identify the relationships between tangle events and accompanied mental disorders. There are often different descriptions of the same controversial conclusion. This thesis introduce the conception of contribute degree and discusses the causality of tangle events and accompanied mental disorders in forensic mental trauma assessments.

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

OBJECTIVE@#To explore the feasibility of Diminished Criminal Responsibility Rating Scale(DCRRS) to schizophrenia offenders.@*METHODS@#The DCRRS were used respectively to 325 cases of schizophrenia offender which were divided into three groups according to the degree of criminal responsibility.@*RESULTS@#There were significant differences in rating score among three groups (mild group 21.16 +/- 4.17, moderate group 25.87 +/- 5.43, major group 29.35 +/- 4.60), and all items have good correlation with the total score of the scale. 6 factors were extracted by the factor analysis, and their cumulative squared loadings is 68.485%.@*CONCLUSION@#The diminished criminal responsibility in schizophrenia offenders could be divided into three grades.