Attempted Serial Neonaticides: Case Report and a Brief Review of the Literature.

Neonaticide is an infant murder occurring on the day of birth. The case reports found in the literature are often focused on the mother as the agent in the context of pregnancy denial, dissociative symptoms, or psychosis. However, this report describes a rare case of attempted serial neonaticides, in which the acts were committed by a nurse at the nursery of a referral hospital in Brazil. The authors describe a forensic psychiatric evaluation for criminal responsibility and correlate the information from this particular case with relevant forensic themes, namely neonaticide, Munchausen by proxy syndrome, and serial healthcare killers.

Phenomenological aspects of the cognitive rumination construct.

OBJECTIVE: To evaluate the importance of phenomenological aspects of the cognitive rumination (CR) construct in current empirical psychiatric research. METHOD: We searched SciELO, Scopus, ScienceDirect, MEDLINE, OneFile (GALE), SpringerLink, Cambridge Journals and Web of Science between February and March of 2014 for studies whose title and topic included the following keywords: cognitive rumination; rumination response scale; and self-reflection. The inclusion criteria were: empirical clinical study; CR as the main object of investigation; and study that included a conceptual definition of CR. The studies selected were published in English in biomedical journals in the last 10 years. Our phenomenological analysis was based on Karl Jaspers' General Psychopathology. RESULTS: Most current empirical studies adopt phenomenological cognitive elements in conceptual definitions. However, these elements do not seem to be carefully examined and are indistinctly understood as objective empirical factors that may be measured, which may contribute to misunderstandings about CR, erroneous interpretations of results and problematic theoretical models. CONCLUSION: Empirical studies fail when evaluating phenomenological aspects of the cognitive elements of the CR construct. Psychopathology and phenomenology may help define the characteristics of CR elements and may contribute to their understanding and hierarchical organization as a construct. A review of the psychopathology principles established by Jasper may clarify some of these issues.

Phenomenological aspects of the cognitive rumination construct / Aspectos fenomenológicos relacionados ao construto de ruminação cognitiva

Objective: To evaluate the importance of phenomenological aspects of the cognitive rumination (CR) construct in current empirical psychiatric research. Method: We searched SciELO, Scopus, ScienceDirect, MEDLINE, OneFile (GALE), SpringerLink, Cambridge Journals and Web of Science between February and March of 2014 for studies whose title and topic included the following keywords: cognitive rumination; rumination response scale; and self-reflection. The inclusion criteria were: empirical clinical study; CR as the main object of investigation; and study that included a conceptual definition of CR. The studies selected were published in English in biomedical journals in the last 10 years. Our phenomenological analysis was based on Karl Jaspers' General Psychopathology. Results: Most current empirical studies adopt phenomenological cognitive elements in conceptual definitions. However, these elements do not seem to be carefully examined and are indistinctly understood as objective empirical factors that may be measured, which may contribute to misunderstandings about CR, erroneous interpretations of results and problematic theoretical models. Conclusion: Empirical studies fail when evaluating phenomenological aspects of the cognitive elements of the CR construct. Psychopathology and phenomenology may help define the characteristics of CR elements and may contribute to their understanding and hierarchical organization as a construct. A review of the psychopathology principles established by Jasper may clarify some of these issues. .

Objetivo: Verificar a importância de aspectos fenomenológicos relacionados ao construto de ruminação cognitiva (RC) nas pesquisas empíricas psiquiátricas atuais. Método: Foram pesquisadas as bases de dados SciELO, Scopus, ScienceDirect, MEDLINE, OneFile (GALE), SpringerLink, Cambridge Journals e Web of Science, entre fevereiro e março de 2014, buscando artigos cujo tópico ou título contivessem os seguintes termos-chave: ruminação cognitiva; escala de resposta ruminativa; e autorreflexão. Os critérios de inclusão foram: estudos clínicos empíricos; RC como principal objeto de pesquisa; e estudos que incluíssem uma definição conceitual de RC. Foram considerados apenas artigos em inglês publicados em periódicos biomédicos nos últimos 10 anos. Nossa análise fenomenológica se fundamentou na Psicopatologia Geral de Jaspers. Resultados: Os conceitos de RC atualmente encontrados nas pesquisas empíricas utilizam majoritariamente elementos fenomenológicos em suas definições. Entretanto, esses elementos cognitivos são indistintamente entendidos como elementos objetivos (empíricos), passíveis de mensuração, e não parecem ser cuidadosamente examinados. Este fato pode contribuir para uma compreensão enganosa sobre RC, além de favorecer a interpretação errônea de resultados e a elaboração de paradoxos teóricos problemáticos. Conclusão: As pesquisas empíricas atuais sobre RC falham ao avaliar os aspectos fenomenológicos inerentes ao construto de RC. A psicopatologia e o método fenomenológico podem ajudar a definir características relacionadas aos elementos da RC, bem como contribuir para a sua compreensão e organização hierárquica enquanto construto. Um retorno aos princípios da psicopatologia, nos moldes de Jaspers, poderia trazer esclarecimentos ao tema. .

Drug-related disorders and the criminal and clinical background of the prison population of São Paulo State, Brazil.

OBJECTIVE: To analyze the association between drug (DAD) and alcohol (AAD) abuse and dependency and criminal and clinical background by gender of prisoners in São Paulo, Brazil. METHOD: Cross-sectional study, random sample stratified by administrative district, from which prisons and prisoners were selected via random, multistage sampling. Psychiatric diagnoses were made with the CIDI 2.1. Lifetime prevalence and 95% CI were calculated and adjusted via analysis of complex samples. Multinomial logistic regression analysis was carried out with four categories of dependent variables: presence AAD; presence DAD; presence of another mental disorder; no mental disorders. For female alcohol and drug abuse and dependency (ADAD) were combined into a single category. RESULTS: The sample was composed by 1809 interviewed prisoners (1192 men and 617 women). Prevalence of DAD and AAD was 25.2% and 15.6%, respectively, among female prisoners, and 26.5% and 18.5% among males. Male prisoners with DAD were more likely to have a criminal record as an adolescent (OR 2.17), to be a repeat offender (OR 2.85), and to have committed a property crime (OR 2.18). Prisoners with AAD were repeat offenders (OR 2.18). Among female prisoners, ADAD was associated with repeat offenses (OR 3.39), a criminal record as an adolescent (OR 9.24), a clinical or infectious condition (OR 5.09), another health problem (OR 3.04), and violent crime (OR 2.5). CONCLUSION: The study confirmed an association between drug-use disorders and the criminal and clinical background in the study population. Prisoners with such disorders were more likely to be repeat offenders and to have a criminal record as adolescents. Among female prisoners disorders were also associated with violent crime and health problems, while among males they were associated with property crime. These patterns in clinical and criminal backgrounds illustrate the need for social rehabilitation programs and specific medical treatment for prison populations.

Prevalence of mental disorders among prisoners in the state of Sao Paulo, Brazil.

OBJECTIVE: To determine the prevalence of psychiatric disorders in the prison population in the State of São Paulo, Brazil. METHODS: Through stratified random sampling, 1.192 men and 617 women prisoners were evaluated for the presence of psychiatric disorders by the Composite International Diagnostic Interview, 2.1 version, according to definitions and criteria of International Classification of Diseases (ICD-10). The prevalence estimates of mental disorders and their respective 95% confidence intervals were calculated and adjusted for sample design through complex sample analysis. RESULTS: Lifetime and 12-month prevalence rates differed between genders. Lifetime and 12-month prevalence of any mental disorder was, respectively, 68.9% and 39.2% among women, and 56.1% and 22.1% among men. Lifetime and 12-month prevalence of anxious-phobic disorders was, respectively, 50% and 27.7% among women and 35.3% and 13.6% among men, of affective disorders was 40% and 21% among women and 20.8% and 9.9% among men, and of drug-related disorders was 25.2% and 1.6% among women and 26.5% and 1.3% among men. For severe mental disorders (psychotic, bipolar disorders, and severe depression), the lifetime and 12-month prevalence rates were, respectively, 25.8% and 14.7% among women, and 12.3% and 6.3% among men. CONCLUSIONS: This is the first large-scale epidemiological study performed with the prison population in Brazil, revealed high rates of psychiatric disorders among men and women. Many similarities, as well as some differences, were found between our results and those of studies conducted in other countries. The differences observed are more likely due to the peculiarities of the prison systems in each country than to the diagnostic criteria adopted in the studies. This fact reinforces the importance of conducting such studies as part of planning and development of appropriate policies for the particular mental health needs of specific prison populations.

Cerebral calcifications and schizophreniform disorder / Calcificações cerebrais e transtorno esquizofreniforme

OBJECTIVES: Discuss pathophysiological aspects of cerebral calcifications (CC) and highlight its importance related to the occurrence of neuropsychiatric syndromes. METHOD: Single case report. RESULT: Man 52 years old, 20 years after going through a total thyroidectomy, starts showing behavioral disturbance (psychotic syndrome). He was diagnosed as schizophrenic (paranoid subtype) and submitted to outpatient psychiatric treatment. During a psychiatric admission to evaluate his progressive cognitive and motor deterioration, we identified a dementia syndrome and extensive cerebral calcifications, derived from iatrogenic hypoparathyroidism. CONCLUSION: The calcium and phosphorus disturbances, including hypoparathyroidism, are common causes of CC. Its symptoms can imitate psychiatric disorders and produce serious and permanent cognitive sequelae. The exclusion of organicity is mandatory in any psychiatric investigative diagnosis in order to avoid unfavorable outcomes, such as in the present case report.

OBJETIVOS: Discutir aspectos fisiopatológicos das calcificações cerebrais (CC) e ressaltar sua importância na ocorrência de síndromes neuropsiquiátricas. MÉTODO: Relato de caso individual. RESULTADO: Homem 52 anos de idade, 20 anos após tireoidectomia total, iniciou com alteração comportamental (síndrome psicótica), foi diagnosticado como portador de esquizofrenia paranoide e encaminhado para ambulatório de psiquiatria. Durante internação psiquiátrica, para avaliação de importante deterioração cognitivo e motora, foi verificada a vigência de síndrome demencial e extensas CC, secundários a hipoparatiroidismo iatrogênico. CONCLUSÃO: Os distúrbios do metabolismo do cálcio e do fósforo, incluindo o hipoparatiroidismo, são causas frequentes de CC. Seus sintomas podem mimetizar transtornos psiquiátricos e provocar sequelas cognitivas permanentes. A exclusão de organicidade é mandatória durante toda investigação diagnóstica na psiquiatria, a fim de evitar desfechos desfavoráveis, como no presente relato de caso.

Accuracy of the Historical, Clinical and Risk Management Scales (HCR-20) in predicting violence and other offenses in forensic psychiatric patients in Brazil.

BACKGROUND: Assessing the risk of violence is a complex task. In Latin America it is often based on clinical criteria that are not very objective or structured. HCR-20 has been used to increase the accuracy of this exam. AIMS: The aim of this study was to examine the predictive validity of the Historical, Clinical and Risk Management Scales (HCR-20) violence risk assessment scale on a sample of Brazilian male forensic psychiatric inpatients. METHOD: A concurrent prospective cohort design was used. The cohort was selected among the population of inpatients in Unit D (N=68) at Instituto Psiquiátrico Forense Mauricio Cardoso (IPF), Brazil. For the baseline assessment the following instruments: HCR-20-Assessing Risk for Violence, Version 2, and Hare Psychopathy Checklist, Revised (PCL-R) were used. During the one-year follow up, episodes of violent and/or anti-social behavior were assessed, and recorded on the Yudofsky's Overt Aggression Scale (OAS) and Tengström et al.'s Follow-Up Questionnaire. The accuracy of HCR-20 and PCL-R to predict violent and/or anti-social behavior was assessed. RESULTS AND CONCLUSIONS: For the whole cohort, the mean total score of PCL-R was 13.54 and of HCR-20 it was 23.32. The rate of recidivism in the twelve month follow up was 73.5%. Outstanding among the risk factors explored for their predictive efficacy are scale HCR-20 and subscale H for any event, and scale HCR-20 for a violent event. The predictive efficacy of scales HCR-20 and PCL-R was greater for any antisocial event than for a violent event. By taking into account the possibility of recidivism and the probability of recidivism accumulated over time, instruments HCR-20 and PCL-R behaved as expected. In all these explorations, the instruments significantly differentiated the group of the sample that recidivated earlier.

Reliability of the Brazilian version of 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.

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.

Morbidade psiquiatrica na populacao urbana de Porto Alegre

O presente trabalho descreve a metodologia e os resultados do segmento de Porto Alegre, Rio Grande do Sul do Estudo Multicentrico de Morbidade Neurologica e Psiquiatrica em Areas Urbanas Brasileiras. E a primeira experiencia em nosso meio de ampla investigacao de diagnosticos psiquiatricos em populacoes urbanas. Realizada de julho de 1990 a janeiro de 1991, determinou, atraves de um instrumento de screening (QMPA), na sua primeira fase, e com IS-DSM-III na segunda fase, a prevalencia de diagnosticos psiquiatricos nesta populacao. A prevalencia estimada de morbidade psiquiatrica nessa amostra foi de 49 por cento, sendo os tres diagnosticos mais frequentes encontrados: transtornos do uso de substancias psicoativas (24,6 por cento), transtornos de ansiedade (23 por cento) e transtornos afetivos (10,7 por cento).

Morbidade psiquiátrica na populaçäo urbana de Porto Alegre / Psychiatric morbidity of urban population in Porto Alegre

O presente trabalho descreve a metodologia e os resultados do segmento de Porto Alegre, Rio Grande do Sul do Estudo Multicêntrico de Morbidade Neurológica e Psiquiátrica em Areas Urbanas Brasileiras. É a primeira experência em nosso meio de ampla investigaçäo de diagnósticos psiquiátricos em populaçöes urbanas. Realizada de julho de 1990 a janeiro de 1991, determinou através de um instrumento de screening (QMPA), na sua 1§ fase, e com IS-DSM-III na 2§ fase, a prevalência de diagnósticos psiquiátricos nesta populaçäo. A prevalência estimada de morbidade psiquiátrica nessa amostra foi de 49 por cento, sendo os três diagnósticos mais frequentemente encontrados: transtornos do uso de substâncias psicoativas (24,6 por cento), transtornos de ansiedade (23 por cento) e transtornos afetivos (10,7 por cento)

Morbidade psiquiátrica na populaçäo urbana de Porto Alegre / Psychiatric morbidity on the urban population in the city of Porto Alegre

O presente trabalho descreve a metodologia e os resultados do segmento de Porto Alegre, Rio Grande do Sul do Estudo Multicêntrico de Morbidade Neurológica e Psiquiátrica em Areas Urbanas Brasileiras. É a primeira experiência em nosso meio de ampla investigaçäo de diagnósticos psiquiátricos em populaçöes urbanas. Realizada de julho de 1990 a janeiro de 1991, determinou, através de um instrumento de screening (QMPA), na sua 1ª fase, e com IS-DSM-III na 2ª fase, a prevalência de diagnósticos nesta populaçäo. A prevalência estimada de morbidade psiquiátrica nessa amostra foi de 49//, sendo os três diagnósticos mais frequentemente encontrados: transtornos do uso de substâncias psicoativas (24,6//), transtornos de ansiedade (23//) e transtornos afetivos (10,7//)

Morbidade psiquiatrica na populacao urbana de Porto Alegre

O presente trabalho descreve a metodologia e os resultados do segmento de Porto Alegre, Rio Grande do Sul do Estudo Multicentrico de Morbidade Neurologica e Psiquiatrica em Areas Urbanas Brasileiras. E a primeira experiencia em nosso meio de ampla investigacao de diagnosticos psiquiatricos em populacoes urbanas. Realizada de julho de 1990 a janeiro de 1991, determinou, atraves de um instrumento de screen-ing (QMPA), na sua primeira fase, e com IS-DSM-III na segunda fase, a prevalencia de diagnosticos psiquiatricos nesta populacao. A prevalencia estimada de morbidade psiquiatrica nessa amostra foi de 49 por cento, sendo os tres diagnosticos mais frequentemente encontrados: transtornos do uso de substancias psicoativas (24,6 por cento), transtornos de ansiedade (23 por cento) e transtornos afetivos (10,7 por cento).