Trastorno Límite de la Personalidad y Filicidio: Discusión de caso

La violencia contra los niños es una preocupación muy importante en el sistema de salud pública. El filicidio es un acto deliberado de una madre o un padre que mata a su propio hijo. El objetivo de este estudio es describir un caso de filicidio asociado a la presencia del Trastorno Límite de la Personalidad (TLP), analizando la evaluación de la imputabilidad criminal relacionada con este caso, utilizando el criterio biopsicológico. Medidas de protección a los niños deben ser ofrecidas de forma activa cuando los padres tienen estrés y falta de equilibrio emocional, y al mismo tiempo deben cuidar a los niños.

Violence against children is a very important concern in the public health system. Filicide is a deliberate act of a mother or father killing his own child. The aim of this study is to describe a case of filicide associated with the presence of borderline personality disorder, discussing the evaluation of criminal imputability related to this case, using the biopsychological criterion. Child protection measures should be actively offered when parents have stress and lack of emotional balance while needing to care for children.

Relationship between epileptic seizures and criminal behavior: a systematic literature review / Relação entre crises epilépticas e comportamento criminoso: uma revisão sistemática da literatura

Objective: The principal objective aims to assess a possible relationship between epilepsy and aggressive behavior. Secondarily, we intend to study how epilepsy relates to criminal liability. Methods: A systematic literature review was performed, using the Web of Science,United States National Library of Medicine (PubMed),and Scielo databases. The searches were conducted in May-June 2022 and covered the period from 2000 to 2022. Eligibility criteria consisted on original articles in English and Portuguese that were interested in the association of epilepsy, criminal behavior (with aggression directed to others), criminal liability in adults with epilepsy. Results: The search yielded 921 results, 794 of which in PubMed, 115 in Web of Science, and 12 in Scielo. Articles that failed to meet the inclusion criteria (206) and duplicates (201) were excluded. Conclusion: There were no findings to indicate a significant increase in aggressive behaviors in individuals with epilepsy. However, it was possible to identify a higher prevalence of aggressive acts in males with epilepsy, besides the presence of comorbidities with mental disorders and substance use. In addition, the results suggest that in criminal offenders with epilepsy, the seizures originated in the temporal and frontal cerebral lobes. Further researchis necessary on the relationship between epilepsy, criminality, and criminal liability in order to produce more robust data to support legal proceedings.

Objetivo: O objetivo principal visa avaliar uma possível relação entre epilepsia e comportamento agressivo. Secundariamente, pretendemos estudar a relação entre epilepsia e responsabilidade penal. Método: Foi realizada uma revisão sistematizada da literatura, utilizando as bases de dados Web of Science, United States National Libraryof Medicine (PubMed) e Scielo. As buscas ocorreram no período de maio e junho de 2022, verificando o período de 2000 à 2022. Os critérios de elegibilidade consistiram em artigos originais em inglês e português, com interesse na associação entre epilepsia, comportamento criminoso (com violência direcionada a outros) e responsabilidade penal em adultos com epilepsia. Resultados: Foram encontrados 921 resultados na busca, sendo 794 na base de dados PubMed, 115 na Web of Science, e 12 na Scielo.Aqueles que não preencheram os critérios de inclusão (206) e duplicados (201) foram excluídos. Conclusão: Não houveram achados suficientes que indicassem um aumento significativo de comportamentos agressivos na população epiléptica. Entretanto, em relação a esse aspecto, foi possível estabelecer maior prevalência no sexo masculino, presença de comorbidades com transtornos mentais, além de uso de substâncias. Além disso, os resultados sugerem que, em infratores epilépticos, as crises foram provenientes das regiões temporo-frontais do cérebro. Em suma, é importante que a relação entre comportamento criminoso, epilepsia e imputabilidade penal continue sendo estudada, de modo a trazer dados mais sólidos para embasar procedimentos judiciais.

Matricide and schizophrenia- psychopathological, psychodynamic, and forensic aspects: a case report.

Matricide is the murder of a mother by her son or daughter, a form of homicide rarely seen in psychiatric practice. A narrative review was conducted on the relationship between matricide and schizophrenia, followed by a case report in Brazil of a schizophrenic patient who murdered his mother and was submitted to forensic psychiatric assessment for criminal liability. The article discusses psychopathological, psychodynamic, and forensic aspects related to the case. The observation of ambivalent and conflictive relations between schizophrenic individuals and their mothers suggests the need for family-level interventions to resolve the understandable occurrence of emotional conflicts, which can serve as stimuli that trigger the murder.

The efficacy of CBT based interventions to sexual offenders: A systematic review of the last decade literature.

Sexual violence is a significant public health problem and a devastating issue for mental health throughout the world. Clinicians and researchers have worked, over the last decades, to develop effective strategies aimed at reducing sexual abuse rates. Multiple treatment approaches for sex offenders have been developed, with Cognitive Behavioral Therapy (CBT) been the most widely used therapy model with recognized effectiveness. In this sense, the present study aimed to analyze and evaluate the effectiveness of CBT based interventions in the treatment of individuals convicted of sexual crimes. For this purpose, a systematic review of articles published between 2012 and 2022 was carried out in the databases Pubmed, Science Direct, APA PsycNet and Scielo, with the keywords "cognitive behavioral therapy", "CBT", "sexual offender", "sexual crimes" and others. As a result, eight studies were selected that met the defined inclusion criteria. Cognitive-behavioral interventions have shown great promise in reducing sexual crime recidivism and improving self-control, emotional regulation, intra and interpersonal social skills, supporting the hypothesis that CBT may be a promising model of intervention in forensic settings with sex offenders.

Cessation of dangerousness status in Brasília, Brazil: An analysis of 144 reports from Federal District Medical Examiner's Office in the last 10 years.

The aim of this study is to evaluate factors related to cessation of dangerousness of individuals under safety measures, through the study of psychiatric reports. This is a cross-sectional study, conducted through a retrospective analysis of expert psychiatric dangerousness cessation reports issued by the Federal District Coroner's Office, Brasília, Brazil. By examining official files, information was extracted from the reports (socio-demographic data, clinical characteristics, type of crime, historical characteristics and the search for items related to risk assessment present in instruments such as Historical, Clinical and Risk Management [HCR-20], Psychopathy Checklist - Revised [PCL-R], Two-Tiered Violence Risk Scale [TTV], Short-Term Assessment of Risk and Treatability [START] and others) and submitted to statistical analysis and then compared to other studies on the subject. The items most considered by the experts were those referring to PCL-R, START and the "non static" part of HCR-20 and TTV. For the non-cessation of dangerousness, we've found: absence of remorse, fragile behavioral control, early behavioral problems, juvenile delinquency. For the cessation of dangerousness, we've found: presence of social skills, balanced emotional state, presence of social support, adherence to rules, good coping strategies, involvement with treatment and adherence. The systematization and standardization of forensic psychiatric reports needs to be established and the use of risk assessment instruments are essential to support better decisions by the experts.

Factors Associated with Prolonged Institutionalization in Mentally Ill People with and Without a History of Violence and Legal Involvement: A Cross-Sectional Study.

This is a cross-sectional study carried out on 34 individuals hospitalized for a long period in the Federal District, in Brazil. To evaluate factors related to prolonged institutionalization in mental patients with history of violence and criminal records. Individuals found were assorted into two groups: with and without criminal records. We analyzed 56 items by reviewing medical records and health records. Demographic and social data, history of violence, criminal involvement, medical history, substance use, and other aspects related to long hospitalizations, by reviewing medical and health records. We found a profile of male individuals: single, male, with an average age of 47.6 years, low education, and little professional qualification from correctional facilities or long-term psychiatric clinics and hospitals. Most men had a history of aggressive behavior, a leading psychiatric diagnosis of psychosis, and an issue with polypharmacy. Two factors showed statistical significance and were highly related to longer institutionalizations: polypharmacy and records of hospitalization for violent behavior. Further studies with these populations are needed to increase knowledge on the subject. They can help health care systems to improve and provide broad, humanized and quality assistance with multi-professional teams, aiming to reduce prolonged hospitalizations.

Case Report: Depression × dementia with Lewy bodies in the elderly: The importance of differential diagnosis.

Background: Dementia is a clinical syndrome which is more common in elderly people. Dementia with Lewy bodies (LBD) is not so rare in elderly people, with cognitive impairment in about 30% over age 65. The clinical picture is characterized by fluctuation in cognitive functions, recurrent, well-formed, detailed visual hallucinations, and Parkinsonism, with rigidity, tremor, bradykinesia, and slurred speech. Case presentation: We present a case report of LBD in a 73-year-old retired teacher, which a initial wrong diagnosis of refractory depression for at least 3 years. We also conduct a review of recent works on theme. Conclusion: LBD diagnosis can be neglected for years, with a legal and clinical issues to patients and their families. Detailed medical research, including differential diagnosis, are very necessary on those cases, specially when they are called refractory. We encourage new research and adequate clinical training to prevent damage.

Antisocial and borderline Personality disorder, violent behavior and covid-19

The combination of severe personality disorders and violence poses a challenge for mental health services, including forensic services and community mental health services. In the context of COVID-19 pandemic, after observing the alarming number of cases of coronavirus and deaths in Brazil, we aimed to discuss the potential increase in hostile behavior, violence and crime in individuals with personality disorders. A literature review was conducted on antisocial and borderline personality disorders and the possible implications on violent behavior of these personality disorders, during the Covid-19 pandemic. We reviewed Medline database articles on these topics between the years 2000 and 2020. During the pandemic it is important that these services be attentive and prepared for new demands and worsening of previously stabilized individuals of borderline personality disorder and antissocial personality disorder.(AU)

A combinação de transtornos de personalidade grave e violência representa um desafio para os serviços de saúde mental, incluindo os serviços forenses e os serviços comunitários de saúde mental. No contexto da pandemia do COVID-19, após observar o número alarmante de casos de coronavírus e mortes no Brasil, objetivamos discutir o potencial aumento do comportamento hostil, da violência e da criminalidade em indivíduos com transtornos de personalidade. Foi realizada uma revisão da literatura sobre os transtornos borderline e antisocial e as possíveis implicações no comportamento violento desses transtornos de personalidade durante a pandemia do Covid-19. Revisamos artigos da base de dados Medline sobre esses temas, entre os anos 2000 e 2020. Durante a pandemia é importante que esses serviços fiquem atentos e estejam preparados para novas demandas e agravamento de indivíduos previamente estabilizados de transtorno borderline de personalidade e transtorno de personalidade antissocial.(AU)

La combinación de trastornos graves de personalidad y violencia plantea un desafío para los servicios de salud mental, incluidos los servicios forenses y los servicios comunitarios de salud mental. En el contexto de la pandemia COVID-19, después de observar el alarmante número de casos y muertes de coronavirus en Brasil, nos propusimos discutir el posible aumento de la conducta hostil, la violencia y la delincuencia en individuos con trastornos de personalidad. Se realizó una revisión de la literatura sobre trastornos limítrofes y antisociales y las posibles implicaciones en el comportamiento violento de estos trastornos de la personalidad durante la pandemia de Covid-19. Se revisaron artículos de la base de datos Medline sobre estos temas entre los años 2000 y 2020. Durante la pandemia es importante que estos servicios estén atentos y preparados para nuevas demandas y el empeoramiento de individuos previamente estabilizados de trastorno límite de la personalidad y trastorno antisocial de la personalidad.(AU)

Matricide, parricide, and filicide: Are major mental disorders or personality disorders involved? Assessment of criminal responsibility in Brazilian cases.

Violence committed by individuals with severe mental disorders has become a growing focus of interest among physicians, law enforcement officials, and the general population. Homicide involving relatives, specially parricide, matricide, and filicide, despite the relatively low incidence of these crimes, may be enigmatic, so forensic psychiatrist are frequently called on the courts to answer questions about insanity and criminal responsibility. The current study aims to describe Brazilian cases of parricide, matricide, and filicide associated with presence of major mental disorders and personality disorders, discussing the assessment of criminal responsibility in each case. The case series described were specifically related to people with mental illness, as bipolar disorder, schizophrenia, and borderline personality with comorbidity of drug abuse. Two of them were considered not guilty by reason of insanity, and the other one was considered partially criminally responsible, according to Brazilian Law and Forensic Psychiatric Reports of the cases. The justice determined compulsory psychiatric treatment for all of them. The question of criminal responsibility of individuals with mental disorders is challenging for criminal justice, psychiatry, and society. Adequate treatment is mandatory to prevent crimes involving mental disorders, as shown in literature. The verification of criminal responsibility is essential for persons' adequate referral in any system of criminal law, thus protecting human rights and referring those who need psychiatric treatment.

Factors related to bias in forensic psychiatric assessments in criminal matters: A systematic review.

OBJECTIVE: Identify factors related to bias in forensic psychiatric assessments in criminal matters. METHOD: Based on the PRISMA guidelines, we searched the following keywords with Boolean operators: (criminal responsibility OR legal responsibility OR neurolaw OR insanity defense) AND (forensic psychiatry OR assessment OR evaluation OR bias OR decision-making OR capacity OR psychometric). The search included publications from January 1998 to December 2019 in the English language, published in PubMed, Web of Science, Taylor & Francis, and Scopus databases. RESULTS: The final sample consisted of 30 articles separated into three groups: (1) legal elements and the wording of expert reports, (2) psychometric tools applied to criminal inquiries, and (3) expert forensic technique and inter-examiner agreement. DISCUSSION: Multiple factors for biases were identified: difficulties in equivalence between legal and psychiatric terminologies, elements of countertransference between the expert and the examinee, absence of standardization of expert evaluations, low quality of expert reports, differences in the training of professionals involved in the evaluations, use of psychometric tools, number of professionals working on the same case, and the methodology adopted. Psychometric tools developed specifically for forensic psychiatric evaluations allowed the introduction of objective parameters in expert evaluations. Special attention was found in psychometric tools structured as vignettes that allowed the detailed evaluation of legal capacities, present in the legal texts. Psychometric tools in checklist format appeared to be more susceptible to interviewer biases. CONCLUSION: The control of inherent biases in forensic psychiatry assessments on criminal matters remains a current challenge, difficult to control in forensic practice. The identification, control and avoidance of them may improve the quality the forensic psychiatric expertise in criminal matters.

Violent behavior by involuntarily committed female offenders with mental disorders: A population-based case series.

The goal of the current study was to investigate the socio-demographic, psychiatric, and criminological characteristics of female violent offenders with mental disorders involuntarily committed to a forensic psychiatric hospital. The present study was a population-based retrospective case series including all female offenders with mental disorders found not guilty by reason of insanity by the criminal courts in the state of Rio de Janeiro, Brazil, and involuntarily committed to a forensic psychiatric facility (n = 27). Patients were assessed with Structured Clinical Interview for DSM-IV Axis I Disorders and the Positive and Negative Syndrome Scale. We found that most offenders were Afro-Brazilian, uneducated unmarried women. Schizophrenia with active psychotic symptoms was the most common clinical condition. Relatives were the frequent victims of aggressive behavior. Most patients had already been diagnosed with a mental disorder and placed under psychiatric treatment, but poor adherence and treatment dropout were common. Violent behavior in psychiatrically ill female patients is associated with a specific socio-demographic and clinical profile and is thus potentially amenable to prevention particularly if the mental health and social services are to provide the much-needed support for economically, socially, and psychologically vulnerable women.

Criminal Responsibility Scale: Development and Validation of a Psychometric Tool Structured in Clinical Vignettes for Criminal Responsibility Assessments in Brazil.

Criminal responsibility assessment is undertaken by psychologists or psychiatrists to assess offenders' legal capacities, which vary among countries or regional legislations. There are two psychometric tools (i.e., checklists) validated for criminal responsibility assessment: the Roger Criminal Responsibility Scale, and the rating scale of criminal responsibility for mentally disordered offenders. Despite the existence of psychometric tools structured in clinical vignettes for evaluating legal capacities, none serve the purpose of assessing criminal responsibility. This study aims to validate a novel psychometric tool structured in vignettes for the assessment of criminal responsibility called the "Criminal Responsibility Scale." We applied the tool to 88 defendants referred for criminal responsibility assessment in a forensic medical institute in the city of Rio de Janeiro, Brazil, from December 2017 to December 2018. The validity of the Criminal Responsibility Scale and subscales were evaluated using confirmatory factor analysis. The two-factor solution proved satisfactory and met the needs for practical application of the tool (Kaiser-Meyer-Oklin = 0.82; p < 0.001). Moreover, the inter-rater reliability was evaluated by comparing the tool's final score with that of the expert's conclusion in each case and was found to be satisfactory (k = 0.667-1.0), with a resulting cutoff point of 30.50 (±2) and a Youden index of 0.509. Hence, the Criminal Responsibility Scale is an effective psychometric tool for assessments of criminal responsibility that may encourage future research in assessments of legal capacity with clinical vignette-based psychometric instruments.

Evaluación de imputabilidad penal en crímenes sexuales / Assessment of criminal imputability in sexual crimes

Resumen El artículo tiene como objetivo definir el crimen sexual y estudiar la relación entre los crímenes sexuales y los trastornos mentales. También se describen aspectos del peritaje psiquiátrico de las personas que han cometido delitos sexuales. La evaluación de la imputabilidad penal es extremadamente importante para ajustar, en cada caso, la aplicación de medidas de seguridad y las sanciones penales y correccionales apropiadas.

This article aims to define sexual crime, to study the relationship between sexual crimes and mental disorders. Aspects of psychiatric expertise of individuals Who have committed sex crimes are also described. The assessment of criminal imputability is extremely important in order to adjust, in each case, the application of security measures and appropriate criminal and correctional sanctions.