Forensic Implications of the New Classification of ICD-11 Paraphilic Disorders in Brazil.

INTRODUCTION: The World Health Organization (WHO) Department of Mental Health and Substance Abuse appointed a Working Group on Sexual Disorders and Sexual Health in order to revise and propose changes to ICD-10 categories. AIM: Analyze ethical and legal implications in Brazil of the proposed ICD-11 diagnostic criteria for paraphilic disorders. METHODS: A forensic working group of Brazilian experts in collaboration with representatives of WHO reviewed the proposed modifications to the classification of Disorders of Sexual Preference in ICD-10 (F65), which is recommended to be replaced by Paraphilic Disorders in ICD-11. Proposals were reviewed through a medicolegal lens, using a legal and policy analysis guide put forth by WHO. The premise of this review was to understand that, although the ICD classification is intended to provide a basis for clinical and statistical health interventions, medical diagnostics may also be entangled in the complex legal, normative, and political environment of various countries. MAIN OUTCOME MEASURE: The most important proposed change to this section is to limit the concept of paraphilic disorders primarily to patterns of sexual arousal involving a focus on others who are unwilling or unable to consent, but this change has not affected the ethical and legal aspects of psychiatric functioning in the Brazil. RESULTS: Because Brazilian criminal law is directed toward criminal behavior and not to specific psychiatric diagnoses, the changes proposed for ICD-11 are not expected to create obstacles to health services or to modify criminal sentencing. CLINICAL IMPLICATIONS: Although ICD-11 has a number of changes in its content, there are no significant clinical implications in the Brazilian context, but a better clarity of conceptual definitions and diagnostic criteria. STRENGTHS & LIMITATIONS: The study is conducted with people from different Brazilian states, which is important for a comprehensive view. On the other hand, considering that it is a very heterogeneous country, there is the limitation that an even wider scope of the study is not possible. CONCLUSION: In the Brazilian context, the new guidelines for paraphilic disorders contribute to clinical utility and are not expected to create difficulties related to the legal, social, and economic consequences of sexual offenses in the country. Abdalla-Filho E, de Jesus Mari J, Diehl A, et al. Forensic Implications of the New Classification of ICD-11 Paraphilic Disorders in Brazil. J Sex Med 2019; 16:1814-1819.

Psychiatric evaluation of civil capacity with the new Brazilian Statute of the Person with Disabilities

The objective of this paper is to provide an update to psychiatrists regarding the new Brazilian Law for the Inclusion of People with Disabilities (BLI, Law 13,146 of 2015), and, specifically, to discuss potential implications of situations in which examination by a forensic psychiatrist points toward civil incompetence, while the above-mentioned law mandates full civil capacity for disabled persons. A study of Law 13,146/2015 was conducted, including a comparative analysis of legal and psychiatric approaches on the subject. This analysis revealed that the BLI has generated differences of opinion among legislators. However, the greatest difference seems to arise between the justice system and psychiatric expertise in relation to the difference of criteria adopted in the two approaches. The BLI is very recent; it should be revised in response to debates among psychiatrists and the criminal justice system, and especially as jurisprudence is formed over time.

Psychiatric evaluation of civil capacity with the new Brazilian Statute of the Person with Disabilities.

The objective of this paper is to provide an update to psychiatrists regarding the new Brazilian Law for the Inclusion of People with Disabilities (BLI, Law 13,146 of 2015), and, specifically, to discuss potential implications of situations in which examination by a forensic psychiatrist points toward civil incompetence, while the above-mentioned law mandates full civil capacity for disabled persons. A study of Law 13,146/2015 was conducted, including a comparative analysis of legal and psychiatric approaches on the subject. This analysis revealed that the BLI has generated differences of opinion among legislators. However, the greatest difference seems to arise between the justice system and psychiatric expertise in relation to the difference of criteria adopted in the two approaches. The BLI is very recent; it should be revised in response to debates among psychiatrists and the criminal justice system, and especially as jurisprudence is formed over time.

Diretrizes éticas na prática pericial criminal / Ethical guidelines in criminal investigation practices

Este artigo de pesquisa discute aspectos peculiares ao exercício da função de perito criminal, o qual, frequentemente, se depara com situações em que há contraposição entre seus deveres profissionais e seus princípios éticos. Por meio da aplicação de questionário aos peritoscriminais do Instituto de Criminalística da Polícia Civil do Distrito Federal, o presente estudo objetivou verificar a existência de diretrizes éticas adotadas atualmente por esses profissionais e examiná-las com o intuito de gerar reflexões bioéticas, além de propor ajustes consideradosnecessários. O estudo permitiu concluir que há insatisfação entre os profissionais a respeito das orientações éticas recebidas, bem como referente à opinião negativa sobre a abordagem ética de seus pares e, principalmente, quanto à necessidade de referenciais éticos específicos para a prática pericial criminal, especialmente quando do trato com o cadáver e seus familiares.

Mental disorders in prisons.

PURPOSE OF REVIEW: The existence of people with mental disorders in prisons is a reality found worldwide. The purpose of this article is not only to review the publications on this subject in 2009 but also to stimulate discussions that could contribute to its further scientific study. RECENT FINDINGS: Most studies published in 2009 related to drug use among inmates and its consequences made it clear that this kind of disorder has a closer relationship with the crime than with mental illness. SUMMARY: The existence of the mentally ill in prisons is a complex issue and the studies attempt to analyze aspects such as the type of disorder, sex of criminals, the opposition between incarceration and treatment, policy, harm reduction and stigma. A further study on the variables raised in this work is required, as well as examining others, to the extent that they are relevant to the various socio-economic and cultural realities.

Legal controls of the medical profession.

PURPOSE OF REVIEW: The authors, after a brief historical review of the theme, review the articles published in the last year. The purpose is to verify how the field has moved on during this period, as a constant increase of legal and social controls on the medical profession is perceived. RECENT FINDINGS: Surprisingly, very few articles treating directly the theme reviewed were found. The better part of the articles examined legal aspects of the medical profession in a nonsystematic way. Among the ones selected those that dealt with internal controls (produced by the professional categories such as the Clinical Practice Guidelines) and those that dealt with external controls (produced by other social groups) could be identified. SUMMARY: The authors conclude that the existence of limits and internal and external controls is fundamental for a professional medical practice of quality. However, the excess of controls, which causes a defensive attitude, may negatively interfere in the quality of the care offered to patients.

Ethics in forensic psychiatry.

PURPOSE OF REVIEW: Ethics in forensic expertise has been the focus of important debates. After providing a brief history of the theme, a review is given of the articles published in the last 2 years. As this field is constantly changing, it is possible to identify significant differences and even opposing positions adopted till now by various researchers. RECENT FINDINGS: The review includes a discussion on the current ethical theories applied to the forensic field, the objective and subjective issues involved in forensic work, the care needed to prevent additional and unnecessary suffering to the examinees and, finally, future directions as indicated by the authors. SUMMARY: The authors conclude that the discussion on the ethics of forensic expertise should be more comprehensive. The debate should include the search for equilibrium between objectivity and subjectivity, inherent to forensic expertise work, and also the utilization of advanced technological resources, always bearing in mind the conditions to which the examiner and examinee are subjected.

[Forensic psychiatric systems in the world]. / Sistemas de psiquiatria forense no mundo.

OBJECTIVE: The study aims to approach forensic psychiatry within different contexts. It endeavors to show how this specific psychiatry science area is influenced by legal and cultural aspects. METHOD: The bibliography reviewed had in view understanding the different ways of how to deal with law within the psychiatric sphere, from a cultural point of view. RESULTS: there is a great heterogeneity, of different nature (legal, political, cultural, and religious) that enrich, but at the same time makes difficult, a debate about this issue. CONCLUSIONS: there are two great obstacles to achieve a good knowledge about the practice of forensic psychiatry all over the world. The first one is represented by a heterogeneity that makes difficult its description in a comprehensible way. The second is the lack of knowledge of the cultural diverse realities. These difficulties should be a stimulus for newer studies of this characteristic. Only in this way it becomes possible to gradually increase the comprehension of this issue.

[Personality disorders, psychopathy and serial killers]. / Transtornos de personalidade, psicopatia e serial killers.

OBJECTIVE: To illustrate the basic characteristics of several specific personality disorders, focusing mainly in antisocial personality disorder. The differences between antisocial personality disorder and psychopathy are highlighted. Serial killers and its psychopathic aspects are also discussed. METHOD: A bibliographic review was completed in order to outline convergences and divergences among different authors about this controversial issue, especially those concerning the possibility of treatment. RESULTS: While anti-social personality disorder is a medical diagnosis, the term "psychopathy" (which belongs to the sphere of forensic psychiatry) may be understood as a "legal diagnosis". It is not still possible to identify an effective treatment for serial killers. CONCLUSION: Personality disorders, especially of the antisocial type, still represent a formidable challenge to forensic psychiatry today. Questions as yet unanswered include the best and most humane place for patients with this condition and the nature of a standardised treatment recommendation.

Sistemas de psiquiatria forense no mundo / Forensic psychiatric systems of the world

OBJETIVO: Este estudo visa a uma abordagem da psiquiatria forense dentro de diferentes contextos, no sentido de mostrar como essa ciência é influenciada por aspectos legais e culturais. MÉTODO: Foi feita uma revisão bibliográfica com o objetivo de apreender formas culturalmente diferentes de se lidar com a lei dentro do campo médico-psiquiátrico. RESULTADOS: Existe uma enorme gama de fatores, de diversas naturezas (legal, política, cultural, religiosa), que enriquece e, simultaneamente, dificulta um debate sobre o tema. CONCLUSÕES: Existem dois grandes obstáculos para se adquirir um conhecimento sobre a prática, em todo o mundo, da psiquiatria forense. O primeiro diz respeito a uma heterogeneidade que dificulta sua descrição de forma clara, e o segundo se refere ao próprio desconhecimento de realidades culturalmente muito diferentes. Por outro lado, essas mesmas dificuldades devem representar um estímulo para novos estudos dessa natureza, objetivando a alcançar, pouco a pouco, uma maior compreensão da matéria

OBJECTIVE: The study aims to approach forensic psychiatry within different contexts. It endeavors to show how this specific psychiatry science area is influenced by legal and cultural aspects.METHOD: The bibliography reviewed had in view understanding the different ways of how to deal with law within the psychiatric sphere, from a cultural point of view. RESULTS: there is a great heterogeneity, of different nature (legal, political, cultural, and religious) that enrich, but at the same time makes difficult, a debate about this issue.CONCLUSIONS: there are two great obstacles to achieve a good knowledge about the practice of forensic psychiatry all over the world. The first one is represented by a heterogeneity that makes difficult its description in a comprehensible way. The second is the lack of knowledge of the cultural diverse realities. These difficulties should be a stimulus for newer studies of this characteristic. Only in this way it becomes possible to gradually increase the comprehension of this issue

Transtornos de personalidade, psicopatia e serial killers / Personality disorders, psychopathy, and serial killers

OBJETIVO: Apresentar as características básicas dos diversos transtornos específicos de personalidade, mas centrando-se no transtorno de personalidade anti-social, fazendo sua diferenciação com psicopatia. O estudo ainda se propõe a abordar a figura do serial killer, apontando a presença de aspectos psicopáticos no homicídio seriado. MÉTODO: Uma revisão bibliográfica foi feita no sentido de se abordar convergências e divergências entre diversos autores sobre um assunto tão polêmico, sobretudo quanto à viabilidade de tratamento dessa clientela forense. RESULTADOS: Enquanto o transtorno de personalidade anti-social é um diagnóstico médico, pode-se entender o termo "psicopatia", pertencente à esfera psiquiátrico-forense, como um "diagnóstico legal". Não se pode falar ainda de tratamento eficaz para os chamados "serial killers". CONCLUSÃO: Os transtornos de personalidade, especialmente o tipo anti-social, representam ainda hoje um verdadeiro desafio para a psiquiatria forense. O local mais adequado e justo para seus portadores, bem como recomendação homogênea e padronizada de tratamento são questões ainda não respondidas

OBJECTIVE: To illustrate the basic characteristics of several specific personality disorders, focusing mainly in antisocial personality disorder. The differences between antisocial personality disorder and psychopathy are highlighted. Serial killers and its psychopathic aspects are also discussed.METHOD: A bibliographic review was completed in order to outline convergences and divergences among different authors about this controversial issue, especially those concerning the possibility of treatment.RESULTS: While anti-social personality disorder is a medical diagnosis, the term "psychopathy" (which belongs to the sphere of forensic psychiatry) may be understood as a "legal diagnosis". It is not still possible to identify an effective treatment for serial killers.CONCLUSION: Personality disorders, especially of the antisocial type, still represent a formidable challenge to forensic psychiatry today. Questions as yet unanswered include the best and most humane place for patients with this condition and the nature of a standardised treatment recommendation

Sobre a psicanálise e a singularidade de analistas e analisandos / On psychoanalysis and the singularity of analysts and analysands

O texto reproduz o conteúdo da apresentação do autor no Pré-Congresso do XXI Congresso Brasileiro de Psiquiatria. Aborda a psicanálise, relacionando-a com sua prática na área e levanta algumas questões que ocorrem frequentemente na prática clínica, como o obetivo da psicanálise, a formação da identidade do analista, a flexibilidade na realização do trabalho, entre outras (AU)

Sobre a psicanálise e a singularidade de analistas e analisandos / On psychoanalysis and the singularity of analysts and analysands

O texto reproduz o conteúdo da apresentação do autor no Pré-Congresso do XXI Congresso Brasileiro de Psiquiatria. Aborda a psicanálise, relacionando-a com sua prática na área e levanta algumas questões que ocorrem frequentemente na prática clínica, como o obetivo da psicanálise, a formação da identidade do analista, a flexibilidade na realização do trabalho, entre outras.

Violência em saúde: quando o médico é o vulnerável / Violence in health: when the doctor is the vulnerable party

A literatura bioética comumente elege alguns personagens como verdadeiros protótipos de sujeitos vulneráveis na área da saúde, dentre eles os pacientes. A figura do médico, por sua vez, desperta atenção não por este prisma, mas exatamente por seu oposto, ou seja, ele é visto como sujeito detentor de poder, sobretudo sobre seus próprios pacientes. Este artigo analisa, sob o vértice bioético, situações que colocam o médico na posição de sujeito vulnerável quando sob pressão advinda da instituição em que trabalha, de colegas profissionais ou mesmo de seus próprios pacientes. Objetiva, ainda, questionar a capacidade de este profissional oferecer condições de saúde a seus pacientes, quando lhe falta a própria saúde mental por se encontrar sob condições de violência emocional.