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月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     

简易精神症状自陈量表对主观夸大精神症状的测试分析

目的 应用简易精神症状自陈量表检测法医精神鉴定中主观夸大精神症状的情况,并分析其测试结果。方法 对206名不同类型的法医精神鉴定的被鉴定人用该量表进行检测．并由两名鉴定专业人员对被鉴定人是否有主观夸大精神症状分别进行评定。结果 （1）以该量表判断主观故意或夸大精神症状的划界分（13分）对测试的被鉴定人进行检测,206例被鉴定人中有71例被判定为主观夸大精神症状（34．5％）。与专家评定的结果相比,量表评定的假阴性为19．8％,假阳性率为1．7％;总准确率为90．8％。（2）工伤和交通事故精神伤残理赔鉴定案例主观夸大精神症状的比例较高（51％）。结论 简易精神症状自陈量表是检测主观夸大精神症状的有效评定工具。     

创伤性湿肺诊断与鉴定差异原因探讨

本文收集我市第一人民医院1992年1月至1996年12月经放射科确诊的、与刑（民）事案件及交通事故有关的、具有完整病案资料的创伤性湿肺病例69例，经法医学检验，最终确诊12例，仅占检验总数的17．3％，说明其放射学诊断与法医学鉴定结果存在明显差异，现对该组资料进行分析，并对产生这种差异的原因作初步探讨。资料分析1．一般情况69例年龄分布符合活体损伤特点（21—40岁60．9％），男女性分别占78．3％和21．7％。2．损伤性质69例均为胸部闭合性损伤，其肋骨骨折者55例（79．7％），无肋骨骨折者14例（20．3％），合并有颅脑损伤者27例（3…     

受虐儿童及青少年法医学鉴定92例分析

本文对92例不满18周岁家庭暴力受虐儿童和青少年法医学鉴定案例进行回顾性研究。结果表明：虐待行为多发生于下午5时前后，受虐者以女性居多（63．04％），损伤部位以头面部最多见（36．98％）。损伤类型以软组织挫伤最常见（51．13％），损伤具有多部位、广泛性、新旧不一等特点；发生场所以家中及家居周围附近为多，受虐者家庭情感生活环境差等.同时，作者还对虐待行为产生的社会根源、受虐儿童及青少年法医学鉴定及法律保护等问题进行了探讨。     

丈夫施暴致伤妇女101例鉴定分析──兼论家庭暴力的法医学鉴定

本文对101例因丈夫施暴致妻子损伤法医学鉴定的资料进行整理分析。资料显示，暴力类型以拳打脚踢为主（49．50％），持械与否在所致损伤程度上没有差异（P＞0．05）。家庭暴力对受伤害妇女造成多种类型的躯体和心理方面的损害，常见损伤类型为软组织伤（47．52％）、鼓膜穿孔（9．90％）和骨折（23．76％）。头部（30．03％）及四肢（36．50％）是常见损伤部位，反复伤（5．94％）、复合伤（30．69％）以及虐待伤是家庭暴力的特征性损伤。本文阐述了法医学鉴定与家庭暴力的关系，认为法医能够在发现、认证家庭暴力及支持诉讼等方面为受伤害人提供帮助。     

活体损伤多次鉴定探讨（附9例分析）

活体损伤多次鉴定探讨（附９例分析）王宁敏，汪宏活体损伤法医学鉴定中，有关复核鉴定问题已有报道［１］。但就三次以上的鉴定国内未见系统研究．本文结合９例损伤程度重复鉴定资料，针对此类问题产生的原因及法医学特点进行分析讨论。资料分析１．一般资料：（１）９例...     

159例家庭暴力损伤的法医学鉴定分析

目的 探讨家庭暴力损伤的特点及其有关的法医学鉴定问题。方法 对１９９８年４月～１９９９年１２月间来诊的１５９例家庭暴力损伤鉴定案件进行回顾研究。结果 家庭暴力的受害者绝大多数为妇女（占９３．１％），主要发生在配偶间（８５．５％），其次为虐儿（５％）。家庭暴力一般发生在家中，以晚上为发生高峰。致伤方式以拳脚为主，其次为随手可得的钝器或锐器。损伤多为软组织损伤；有４０％的受害人投诉前未去医院就诊；损伤     

活体鉴定400例放射学特点分析──兼论法医临床学与放射学的关系

为探讨法医临床学鉴定与放射学的关系，本文对４００例活体鉴定就放射学检查的有关问题进行回顾性研究。结果表明：２６６例进行了放射学检查（占６６．５％），其中Ｘ线１７６例（６６．２％），ＣＴ４３例（１６．１％），两者均有的４７例（１７．７％）。放射学检查部位中，Ｘ线以四肢为多，ＣＴ以颅脑为多。误诊率为９．０２％，放射学检查与致伤原因之间有一定关系，轻微伤中不必要的ＣＴ检查多见。并就放射学误诊的法律后果及不必要的放射学检查问题进行了讨论。本文从法医临床学的角度对放射学进行了评价，指出在活体鉴定中可以应用放射学知识协助证明损伤、推断损伤形成机制、个人识别及研究损伤时间。因此法医学鉴定人必须有放射学理论和技术方面的知识。作者还试图提出法医临床放射学。     

老年人损伤特点及法医学鉴定(附63例分析)

老年人受到伤害的法医学鉴定并不少见，有关损伤及其法医学鉴定的特点，国内法医学界尚无报道。本文结合63例老年人伤害案例进行分析，发现老年人受伤害的高发年龄段为60～69岁（85．71％），并具有轻微外力可导致较严重损伤、伤残率高等特点，其案发原因及地点也具有一定的特点。上述特点对法医学鉴定均具有一定的影响，本文就老年人损伤程度鉴定及损害赔偿方面进行了讨论。     

面部损伤的特点及其法医学鉴定

目的 研究面部损伤的特点及法医学鉴定要点。方法 对１９９７年１￣６月期间活体损伤鉴定例中有关面部损伤的案例进行分析，并按年龄段分为３组：Ｉ组（未成年组）〈１８岁，Ⅱ组（青壮年组），１８￣５９岁，Ⅲ组（老年组）≥６０岁。结果 半年期间所有活体检验案例中，面部损伤占总数的４３．４０％（１２３例），其中未成年组１５例，青壮年组１００例，老年组８例。各组研究结果显示：（１）未成年组多因意外事故致伤（６６．     

Antisocial features are not predictive of symptom exaggeration in forensic patients

Purpose

To investigate the predictive value of antisocial personality disorder (ASPD) and features of ASPD (i.e., lack of remorse, blame externalization, and deceitfulness) for symptom exaggeration.

Methods

A sample of forensic psychiatric patients (N = 57) was asked to complete several self‐report instruments (measuring symptom exaggeration, lack of remorse, blame externalization, and offense minimization) and a semi‐structured interview about their most recent offense. To quantify patients’ deceitfulness, the information collected via the semi‐structured interview was checked against the official records of patient's offenses. Additionally, patient's mental disorders and the extent to which patients denied their delinquency were determined by gathering clinician's judgement on this matter from patient records. The relation between symptom exaggeration and the potential predictors of symptom exaggeration was examined through correlational analyses and cross‐tabulation of prevalence rates of symptom exaggeration with prevalence rates of the potential predictors.

Results

Antisocial personality disorder was not a useful predicator of symptom exaggeration. Also, patients who showed little regret for their offenses, or tended to blame their offenses on external factors, or minimized their delinquency, or were inaccurate when reporting their delinquency, had similar levels of symptom exaggeration as those without these tendencies.

Conclusions

Neither ASPD nor antisocial traits, including lack of remorse, blame externalization, and deceitfulness, were meaningfully related to symptom exaggeration and therefore should have no place in the assessment of symptom validity or the detection of malingering. On the contrary; focusing on antisocial traits as indicators of symptom exaggeration is likely to result in large portions of misclassifications.     

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.     

Neuropsychological and Psychological Aspects of Malingered Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is an anxiety disorder that is frequently encountered in litigation, and as such, there is an increased risk for poor effort on cognitive tests, symptom exaggeration, or frank malingering. These are particularly problematic for accurate diagnosis. This article is divided into four sections. First, we address why individuals malinger PTSD as well as the challenges in detecting an invalid PTSD symptom presentation. Second, we discuss issues of cognitive functioning in PTSD and then the prevalence of and common patterns of poor effort on neuropsychological testing among individuals feigning PTSD. Third, we discuss psychological functioning in PTSD and then the prevalence and patterns of functioning on psychological measures of malingering in this population. Finally, recommendations for detecting invalid PTSD symptom presentations are provided.     

罪犯保外就医法医学文证审查278例

总结2006～2008年福建省长乐市检察技术部门所受理的278例＂罪犯保外就医＂文证审查案例,发现：看守所系统的不符合率明显高于监狱系统;在分系统疾病调查中,循环系统、神经系统以及各类传染病的不符合率明显较高。分析原因,可能为：保外就医审批渠道多,缺乏统一规范;鉴定标准陈旧,不符合当前形势;鉴定人适用标准不够严格;缺少鉴定人资质审查机制;鉴定程序不规范,管理混乱。建议从完善鉴定标准、强化审批管理、加强检察监督等方面规范、提高保外就医病残鉴定工作。     

两地区医疗纠纷法医学尸检鉴定质量的比较研究

目的研究影响涉及医疗纠纷法医学尸检鉴定质量差异的原因。方法两个具有代表性的法医学尸检鉴定机构所涉及医疗纠纷的相关案例,进行字2检验、t检验等统计学研究。结果通过字2检验发现,在设定的10个指标中,有7个指标存在显著性差异,提示两鉴定单位在“涉及医疗纠纷的法医学尸检鉴定”中检验手段和标准、规范性等均存在极大的差异。结论通过研究,提示法医学鉴定人素质、尸检的标准化和规范化、尸检检材的提取标准化、死因或疾病的诊断标准、会诊制度及法医学鉴定书的书写规范化等是法医学尸检鉴定质量控制和管理的重要环节。     

An assessment of the usefulness of routine histological examination in hanging deaths

A retrospective study was carried out on 100 randomly selected medico-legal autopsies of victims who had committed suicide by hanging. All cases had undergone full police and coronial investigation. Complete external and internal examinations had been carried out including routine histological examination of organs. The age range of victims was 15-94 years (average, 41.7 years) with a male-to-female ratio of 7:1. External and internal injuries were consistent with the reported events. Diagnoses based purely on histology included hepatic steatosis (n = 16), asthma (n = 3), lymphocytic thyroiditis (n = 2), and pulmonary and cardiac sarcoidosis (n = 1). A large cell carcinoma of the lung and a rectal adenocarcinoma were confirmed. Histological evaluation was, however, of limited usefulness in contributing to the medico-legal evaluation of cases, with careful scene, external and internal examinations providing the most relevant information. The results of histological examination of tissues were all incidental to the cause, mechanism, and manner of death.     

Detection of Malingered PTSD: An Overview of Clinical,Psychometric, and Physiological Assessment: Where Do We Stand?

ABSTRACT: Posttraumatic stress disorder (PTSD) is a condition that can be easily malingered for secondary gain. For this reason, it is important for physicians to understand the phenomenology of true PTSD and indicators that suggest an individual is malingering. This paper reviews the prevalence of PTSD for both the general population and for specific events, such as rape and terrorism, to familiarize evaluators with the frequency of its occurrence. The diagnostic criteria for PTSD, as well as potential ambiguities in the criteria, such as what constitutes an exposure to a traumatic event, are reviewed. Identified risk factors are reviewed as a potential way to help differentiate true cases of PTSD from malingered cases. The question of symptom overreporting as a feature of the disease versus a sign of malingering is discussed. We then examine how the clinician can use the clinical interview (e.g., SIRS, CAPS), psychometric testing, and the patient's physiological responses to detect malingering. Particular attention is paid to research on the MMPI and the subscales of infrequency (F), infrequency-psychopathology (Fp), and infrequency-posttraumatic stress disorder (Fptsd). Research and questions regarding the accuracy of self-report questionnaires, specifically the Mississippi Scale (MSS) and the Personality Assessment Inventory (PAI), are examined. Validity, usability, and cutoff values for other psychometric tests, checklists, and physiological tests are discussed. The review includes a case, which shows how an individual used symptom checklist information to malinger PTSD and the inconsistencies in his story that the evaluator detected. We conclude with a discussion regarding future diagnostic criteria and suggestions for research, including a systematic multifaceted approach to identify malingering.     

Reasons, circumstances and results of repeat forensic medicine autopsy

There are only scant literature data on reasons and circumstances of medico-legal second autopsies. The present study includes 12 second autopsies from the period 1992-1997; the first post-mortem examination took place either in the home country (institutes of pathology) or abroad. 7 of the 12 cases of death investigated happened in Germany (exclusively in hospitals) and 5 of them abroad (Netherlands, Romania, Portugal, Libya). Repeat autopsies were ordered by criminal courts (n = 9), private persons (n = 2) and social insurances (n = 1). The main indication was possible medical malpractice (n = 6); acts of violence (n = 3), insurance questions (n = 2) and accidents (n = 1) followed. The time lapse between death and second autopsy was 2-35 days. It was striking, that German institutes of pathology had partially performed autopsies despite the certification of a non-natural death. Clinical autopsies were stopped twice, when evidence of a possible non-natural death occurred. It could be fundamentally stated, that first autopsies in German institutes of pathology had been carefully performed and sufficiently documented. In these cases the second autopsy presented no or only little additional information, as far as the broader taking of (toxicological) samples is not considered. The final medico-legal expertise was then mainly based on the findings of the clinical first autopsy. However, the concurrence of the forensic expert (instead of the clinical pathologist) is undoubtedly essential for the evaluation of these issues involving frequently questions of malpractice. By contrast, the quality of postmortems performed abroad varies widely. 4 of the 5 first autopsies done abroad were regarded as completely or partly insufficient with superficial or almost absent preparation of organs or contradictions in the medical reports, respectively. A repeat autopsy is absolutely necessary in such cases. On the whole, the initial question could be answered in all second autopsies at least in part. This emphasizes the high value of second autopsies and expertises, especially in non-natural cases of death (10 of 12 deaths were finally judged as non-natural).     

眼科法医学鉴定中须重视的几个方面

正确分析眼外伤后出现视力障碍的原因 ,以保证法医学鉴定的准确性。在大量眼科法医学鉴定中 ,就法医学鉴定中易忽略的屈光不正、弱视与视力障碍和原发性疾病在外伤转归中的影响以及全身性疾病在眼外伤中的影响等方面进行了法医临床学讨论。列举了针对性较强典型案例 ,并作了较详细的分析。对眼外伤后出现视力障碍的原因分析 ,必须作全面综合分析和进行必要的临床检查 ,才能做出正确判断。     

Homogenous Base Rates for Malingering in Neuropsychological Examination of Litigants

Base rates for malingering are often obtained and averaged across multiple clinicians who apply heterogeneous methods for detection (Mittenberg et al., J Clin Exp Neuropsychol 24: 1094?1102, 2002; Young, Psychol Inj Law 8: 200–218, 2015). Our aims of obtaining homogenous base rates included the following: (a) evaluation of all our legal cases in accordance with the guidelines set forth in the position papers by both the National Academy of Neuropsychology and the Association for Psychological Advancement in Psychological Injury and Law, (b) minimal variation between our comprehensive neuropsychological examinations, and (c) determination of base rates of failed effort in 150 consecutively examined legal cases in one medical setting. To assess the various levels of volitional exaggeration, we introduced four gradations of poor effort definitions, which relied on performance validity tests (PVTs). A comparison between two consecutive samples of 75 litigants indicated less frequent poor effort with increasingly more conservative criteria. In our analysis of a subset of litigants who sustained traumatic brain injuries (N?=?115), the four base rates for mild versus moderate-severe TBI groups were equivalent for the two more lenient malingering definitions but varied for the two more conservative definitions. Specifically, for the mild TBI cases investigated, the percentage of three PVT failures (or one PVT failure significantly below chance) arrived at 3.4 %. Our final aim was to compare the base rates of poor effort that were obtained with PVTs to the base rates of emotional and physical symptom endorsement, which were obtained with symptom validity tests (SVTs). No significant correlations emerged in this analysis. The discussion emphasizes the relatively lower base rates of poor effort found in the convenience sample studied in neuropsychological evaluations relative to the higher estimates in the literature (40 +/? 10 %, Larrabee et al., Clin Neuropsychol 23: 841–849, 2009) but not others based on comprehensive review (Young, Psychol Inj Law 8: 200–218, 2015).