四川鼎诚司法鉴定所

四川鼎诚司法鉴定所成立于2004年6月18日．是四川省司法厅登记注册的多专业综合性司法鉴定机构。现有各类专职司法鉴定人员41名，其中具有高级职称的占鉴定人总数的30％，拥有各类鉴定仪器设备40多台。业务范围有法医临床鉴定、法医病理鉴定、骨龄鉴定、血中酒精含量检测、道路交通事故车辆技术鉴定和责任事故评定、文书／痕迹鉴定，以及司法会计、资产评估和保险赔偿等鉴定项目。     

毒品所致精神障碍者刑事责任能力评定现状调查

目的：了解毒品所致精神障碍者刑事责任能力评定现状及鉴定人对此类案件的观点。方法自编《毒品所致精神障碍者责任能力评定调查表》,选择上海市法医精神病鉴定机构的鉴定人为调查对象,通过信访方式收集调查表。结果大部分鉴定人知晓《精神障碍者刑事责任能力评定指南》（简称《指南》）对毒品所致精神障碍者刑事责任能力评定做出了“不宜评定”的特别规定。《指南》颁布前后,所有的鉴定人均未做出过无刑事责任能力的评定;《指南》颁布后,部分鉴定人仍做出完全或限定刑事责任能力的评定。对作案与症状无关、明知吸毒可致精神错乱却放纵吸毒的案例,鉴定人分歧较小。对作案与症状相关、辨控能力丧失的案例,鉴定人分歧较明显。为消除此类案件刑事责任能力评定的分歧,完善立法认同率最高。结论目前在此类案件鉴定实践中,大部分鉴定人并未严格按照《指南》规定执行,刑事责任能力评定仍存在明显分歧。     

交通事故精神伤残程度重新鉴定51例分析

目的探讨道路交通事故所致精神伤残的伤残程度重新鉴定意见改变的原因。方法回顾性分析绍兴市第七人民医院司法鉴定所2009年10月—2011年10月受理的交通事故致精神伤残的伤残程度重新鉴定案件51例。结果要求重新鉴定的案例中,鉴定意见有改变的共计30例(58.82%),其中伤残等级提高8例,伤残等级降低22例。按鉴定意见改变原因分,鉴定人评定时对精神障碍严重程度的理解差异8例,鉴定人自由裁量差异10例,鉴定人对某些精神症状的认识差异2例,鉴定时间差异10例。结论精神伤残程度鉴定应准确把握鉴定时机,减少鉴定人个体差异引起的鉴定意见改变,正确理解条款规定的要求。     

性自我防卫能力评定量表在非精神发育迟滞精神障碍患者中的适用性

目的探讨性自我防卫能力评定量表在非精神发育迟滞精神障碍患者中的适用性。方法收集性自我防卫能力评定案例87例,由经过培训的人员按照精神障碍者性自我防卫能力评定量表（CapacityofSexualSelf—defenseAssessmentScale,CSSAS）进行评分,并与专家鉴定意见进行比较。结果按照专家鉴定意见分组,有性自我防卫能力组、性自我防卫能力削弱组和无性自我防卫能力组的CSSAS评分分别为5．97±5．83、32．22±10．15、61．60±13．02,3组间的差异具有统计学意义（P〈O．01）。量表各条目得分与总分的相关系数为0．59～0．91,全量表的Cronbachd系数为0．96,拆半信度Cronbach理系数分别为0．94和0．91,两部分的相关系数为0．94。按照原始界值分,量表评定结果与专家鉴定意见的Kappa值为0．32（P〈0．01）,重新划定界值分后．两者的Kappa值为0．84（P〈0．01）。因子分析共提取2个因子,方差解释率分别为46．15％和28．93％,判别函数回代94．30％的样本被正确划分。结论CSSAS可应用于非精神发育迟滞精神障碍患者的性自我防卫能力评定,但应重新修订界值分和因子的权重。     

精神病人受审能力影响因素研究

目的探究精神病人受审能力的影响因素。方法对在四川大学华西基础医学与法医学院法医精神病学教研室进行法医精神病学鉴定的170名被鉴定人进行受审能力评定,评定研究对象的受审能力、精神症状,收集其人口学资料、犯罪学资料,采用统计描述、t检验、χ2检验、秩和检验和logistic回归分析等方法研究精神病人受审能力的影响因素。结果BPRS的思维障碍因子、激活性因子、PANSS的P分对受审能力具有显著影响;无受审能力组病理性和不明作案动机比例较高,且与有受审能力组相比差别具有统计学意义;无受审能力组言语智商低于有受审能力组,差别具有统计学意义;无受审能力组精神分裂症比例较高,差别具有统计学意义。结论BPRS的思维障碍因子、激活性因子、PANSS的P分、言语智商、精神疾病诊断、作案动机对精神病人受审能力具有一定影响。     

人体损伤程度量化评定指标损伤系数的研究

在法医临床鉴定中的一般做法，就是按照《人体重伤鉴定标准》、《人体轻伤鉴定标准（试行）》（以下统称标准）评定被鉴定人是否构成重伤、轻伤或轻微伤。由于标准本身跨度较大，同一结论的损伤往往包含了不同程度的损伤。例如从颅脑损伤（昏迷３０分钟以上伴神经系统体征）到持续植物人状态都属重伤，成人深Ⅱ°烧烫伤面积从２％到接近３０％都是轻伤。司法机关按照法医学鉴定结论作出处理，就产生了这样的结局：原本较为精确、可量化的损伤，经过法医临床鉴定转化为粗略的、定性的几类，最后在处理中又要据此作出量化（或相对量化）的处罚…     

癫痫所致精神障碍患者的犯罪学特征研究

目的探讨法医精神病学鉴定中癫痫所致精神障碍患者的犯罪学特征。方法采用自编法医精神病学鉴定案例登记表，对98例癫痫所致精神障碍患者的犯罪学特征进行研究。依据CCMD-3划分为精神病性症状组（51例，52．04％）、人格改变组（42例，42．65％）和智能障碍组（5例，5．31％），并对精神病性症状组与人格改变组犯罪学特征对照分析。结果癫痫所致精神障碍患者违法犯罪者以未婚、青年男性农民为主。其犯罪学特征主要是被鉴定人与被害人双方关系一般（44．9％），无作案前预谋（53．1％），作案目标临时确定（69．4％），使用暴力手段（88．8％），无明显作案诱因（67．3％），作案目的以报复居多（40．4％），现实作案动机（42．9％），作案结果既遂（89．8％），作案次数以1次为主（88．8％），作案类型以凶杀（46．9％）为主，作案后多无自称遗忘（65．3％），作案后多以停留现场、不潜逃等非反侦查表现（57．1％）为主。精神病性症状组和人格改变组在作案预谋（X^2=27．64）、作案目的（X^2=13．0386）、作案动机（X^2=23．5290）和作案后表现（X^2=19．3591）方面的差异均具有统计学意义（P〈0．005），作案目的以报复为主、作案动机以现实动机为主。结论癫痫所致精神障碍患者的犯罪学特征有多以无作案前预谋，多以报复为主要目的，作案后多无反侦查表现。与以精神病性症状为主要表现者相比，以人格改变为主要表现者多在现实动机下以报复为主要目的进行作案，因此在法医精神病学鉴定时应予重视。     

法医临床鉴定中护理依赖问题的探讨

在交通事故人身损害的案件中,常常遇到护理依赖赔偿的问题。本文通过问卷调查,对法医临床鉴定中护理依赖鉴定存在的问题进行探讨。1资料与方法 1.1资料2012年8月至2013年5月重庆法医验伤所法医临床鉴定的500名伤者数据资料,且满足只做过伤残等级鉴定而没有做护理依赖程度、期限鉴定。1.2方法用调查问卷的方式统计被鉴定人的资料,问卷内容包括:①根据《人身损害护理依赖程度评定》(GA/     

法医临床鉴定中护理依赖问题的探讨

正在交通事故人身损害的案件中,常常遇到护理依赖赔偿的问题。本文通过问卷调查,对法医临床鉴定中护理依赖鉴定存在的问题进行探讨。1资料与方法 1.1资料2012年8月至2013年5月重庆法医验伤所法医临床鉴定的500名伤者数据资料,且满足只做过伤残等级鉴定而没有做护理依赖程度、期限鉴定。1.2方法用调查问卷的方式统计被鉴定人的资料,问卷内容包括:①根据《人身损害护理依赖程度评定》(GA/     

Forensic Psychiatric Examination in Criminal Cases in the United States

作者介绍了美国司法精神病鉴定的一些一般情况．美国法医精神病学家常受法院的委托，对刑事被告人进行精神状态鉴定和诉讼行为能力、责任能力评定．本文阐述了在美国的刑事案件审理过程中，对各种诉讼行为能力（包括受审能力、接受处决能力、放弃法定权利能力等）的认识及评定要点。论述了美国法律对判断有无刑事责任能力的历史发展变化．美国联邦及各州法律对刑事被告人责任能力评定中辨认和控制两要素存在不同看法，在司法实践中各州不尽相同，有些州只要鉴定人检查被告人有无辨认能力；有些州只强调有无控制能力；还有些州则要求鉴定人检查被告人有无辨认能力和控制能力，即两种能力都要．鉴定人检查被告人在作案当时有无精神病，主要根据临床经验及病史材料．     

Validation of an Abbreviated Version of the Structured Interview of Reported Symptoms in Outpatient Psychiatric and Community Settings

This study examined the effectiveness of an abbreviated version of the Structured Interview of Reported Symptoms (SIRS-A) in identifying malingered mental illness. The SIRS-A is comprised of 69 items drawn from the SIRS (R. Rogers et al. 1992, SIRS: Structured Interview of Reported Symptoms: Professional Manual. Odessa, FL: Psychological Assessment Resources, Inc.), substantially reducing the administration time. A simulation design was used with three samples; 87 psychiatric outpatients who responded honestly were compared to 29 community-dwelling adults and 24 psychiatric patients instructed to malinger psychopathology. The SIRS-A generated sensitivity comparable to or exceeding that of the SIRS normative data, but specificity was poorer; many genuinely impaired patients were misclassified as malingering. Although these findings suggest the SIRS-A may be an effective means to assess malingering in psychiatric populations, further research assessing the reasons for the elevated false positive rates is necessary.     

Overlooking Feigning Behavior May Result in Potential Harmful Treatment Interventions: Two Case Reports of Undetected Malingering

Clinicians tend to overestimate their ability to recognize feigning behavior in psychiatric patients, especially if it concerns patients who have been admitted for observation. Feigning can be either externally motivated (e.g., for financial compensation, known as malingering) or internally motivated (e.g., to assume the “sick role,” known as factitious disorder). Persistent presentation of severe symptoms is usually associated with the factitious disorder. We present two patients with strong external incentives who consistently and convincingly feigned severe psychiatric symptoms during a protracted period of inpatient observation in a specialized center; both were engaged in a procedure for medical asylum. The first case presented with the clinical picture of a psychotic depression with severe motor symptoms, and the second case showed symptoms of a chronic post-traumatic stress disorder with secondary psychotic symptoms. Both cases were thoroughly investigated but feigning was overlooked, and unnecessary and harmful treatment interventions were given. To prevent iatrogenic damage, we recommend a critical attitude that takes malingering as an option into account in settings where patients are often involved in high stake legal procedures. A clinical sign that might indicate feigning is therapy-resistant symptoms. To rule out feigning a comprehensive, multimethod approach is required, but an active stance toward collateral information is essential. Specialized psychological tests may be useful for preliminary screening, but for their use in culturally diverse populations as in refugee mental health more research is needed.     

Screening for malingering/exaggeration of psychiatric symptomatology in prison inmates using the PICTS Confusion and Infrequency scales

A sample of 76 federal prison inmates with a history or current complaints of significant psychiatric symptomatology at intake were followed for a period of 4-39 months by a psychologist who rated the inmate as malingering (n=12), substantially exaggerating (n=32), minimally exaggerating (n=23), or honestly reporting (n=9) signs and symptoms of schizophrenia, bipolar disorder, major depression, or severe anxiety disorder. The Confusion-revised (Cf-r) and Infrequency (INF) scales of the Psychological Inventory of Criminal Thinking Styles, which had been administered routinely at intake, revealed that only the INF successfully predicted malingering and exaggeration of psychiatric symptomatology even after pre-existing group differences in age, race, and overall criminal thinking were controlled. These results suggest that the INF scale can potentially serve as an effective initial screening measure for malingering/exaggeration in inmates presenting with mental health complaints.     

DSM-5 and Malingering: a Modest Proposal

The DSM criteria for identifying malingering are reviewed and found to be flawed on both conceptual and practical grounds. Alternative models for diagnosing feigned psychiatric, physical, and neuropsychological symptoms are presented. A number of useful features of these systems are highlighted for potential contributions to modified DSM criteria. It is recommended that the present DSM text on malingering be replaced with feigned psychiatric, physical, or neuropsychological symptoms and suggestions for developing criteria for this condition are made.     

A comparison of simulation and known groups in the detection of malingering on the MMPI-2

Three groups of 30 inmates, one instructed to respond honestly, one to fake being mentally ill, and one to fake schizophrenia after being educated to its symptoms, were administered the MMPI-2. These simulation groups were compared to two forensic evaluation groups of 30 pretrial defendants, one believed to be mentally ill and one suspected of malingering based on their psychiatric history, in order to compare the results of simulation with those of the forensic context. The results demonstrated that those instructed to feign psychiatric disorder and those suspected of malingering in the forensic context scored significantly higher on all MMPI-2 validity indicators than did those with a history of psychiatric treatment and those instructed to respond honestly, yet did not differ from each other. These findings suggest that the results of simulation designs are comparable to those obtained from forensic subjects. The F(p) Scale failed to add incrementally to F in discriminating the two defendant groups.     

保外就医法医学鉴定研究(附54例分析)

目的为探索当前我国保外就医的特点，揭示保外就医中存在的问题，为制定有关政策法规提供参考依据，同时探讨保外就医的审查过程中法医学鉴定的必要性。方法两名研究人员从1992—1997年6年期间的司法鉴定资料中筛选出与保外就医有关的法医学鉴定案例，三名研究人员根据既定条件确定研究对象，并进行统计学分析。结果符合条件者共54例，主要年龄范围为20—50岁，罪名分类发现经济性犯罪明显多于非经济性犯罪，前者51例（94．4％），后者3例（5．55％）。提出保外就医申请的理由以单纯病名和主要症状者居多，少有提出辅助症状者，法医学鉴定表明检查结果与申请理由一致者为14例（25．92％），不一致者为40例（74．04％）；进一步鉴定揭示患有疾病确需保外就医者仅为3例（5．55％），而无需保外就医者高达51例（94．4％），其中无病者32例（59．25％），夸大病情者19例（35．18％）。结论本研究提示当前保外就医中犯罪装病、夸大病情等现象明显严重，这与保外就医所经历的中间环节缺乏有效的监督体制有关。因此，单纯以医疗系统进行保外就医鉴定是难以保证法律的公正执行。     

Prevalence of delusional jealousy in psychiatric disorders

Delusional jealousy is a known risk factor for violence and homicide, but little is known about its prevalence in psychiatric disorders. We therefore reviewed retrospectively the psychopathological symptoms at admission and discharge, assessed with the AMDP system, of all patients admitted to the Psychiatric Hospital, University of Munich, Germany, from January 2000 through December 2008 (n=14,309). We identified 72 cases of delusional jealousy (0.5% of the whole sample). The prevalence was highest in schizophrenia and other psychoses (1.3%), and more of the patients with delusional jealousy were men (43 of 72, 59.7%). One-fifth (15 of 72, 20.8%) of the patients with delusional jealousy were aggressive at admission (vs. 6.2% of the total sample). We conclude that delusional jealousy is a comparatively rare phenomenon that is most frequent in schizophrenia and related psychoses. Quite a number of affected patients are aggressive, which may indicate a risk of future violence.     

Claims of amnesia for criminal offenses: psychopathology, substance abuse, and malingering

The forensic psychiatric examiner often encounters defendants who deny memory for their offense. Past research proposes a variety of factors to account for offense amnesia. To date there have been few systematic studies of offense amnesia in relation to psychiatric diagnosis, either alone or in combination with other known factors such as substance use and malingering. We studied 53 pretrial felony defendants who had been referred for psychiatric examination; 40% claimed amnesia for their offense. Examinees with psychotic disorders in general, and schizophrenia in particular, were relatively less likely to claim amnesia than were examinees with other diagnoses. Substance use at the time of the offense and associated substance use disorder diagnoses were positively associated with offense amnesia. Malingering diagnosed by general clinical criteria was a poor predictor of amnesia claims. These data suggests that two prominent reasons for referral for forensic psychiatric evaluation include the presence of psychotic symptoms and claims of amnesia for the offense.     

A Comparison of Forensic and Nonforensic Malingerers: A Prototypical Analysis of Explanatory Models

Explanatory models of malingering strive to understand the primary motivation underlying attempts to feign. Rogers, Sewell, and Goldstein (1994) provided empirical support for the conceptualization of pathogenic, criminological, and adaptational models. In the current study, a prototypical analysis of 221 forensic experts results in a slightly refined formulation: the adaptational model was decomposed into its two broad dimensions (cost–benefit analysis and adversarial setting). An important finding is that the factor structure for the explanatory models remained stable when applied to both forensic and nonforensic cases. As a first investigation, significant differences were observed in prototypical cases of malingering by the category of referral (forensic or nonforensic) and by type of feigning (mental disorders, cognitive impairment, and medical syndromes). Surprisingly, the feigning of medical syndromes appeared to play a relatively prominent role in both forensic and nonforensic cases and to be influenced by the apparent adversarial context of the assessment. Finally, important gender differences were observed, especially with nonforensic prototypical cases of malingering.     

计算机动态姿势图识别伪装平衡功能障碍

目的 建立本实验室用动态姿势图识别非器质性或伪装平衡功能障碍的客观方法.方法 对104例正常受试者行动态姿势图检查后指导其伪装平衡功能障碍再进行动态姿势图检查,将伪装前后的平衡分进行配对t检验;应用以往研究提示伪装的7条标准对本实验的50例伪装前后的姿势图表现(包括原始曲线)进行判别,按照90％的敏感性选取并建立本实验...