The impact of forced forensic psychiatric confinement on composition and structure in the personal networks of personality-disordered forensic psychiatric patients

This study explored to what extent the composition and structure of personal networks of personality-disordered forensic psychiatric patients changed before and after forced confinement in a forensic psychiatric centre. Semi-structured in-depth interviews with 36 patients and selected members of their networks were examined. During forensic psychiatric treatment, patients reported a decrease in network size, in the number of high-risk network members, and in the number of social ties between these high-risk network members. Personal relationships were of shorter duration, with lower levels of contact frequency and reciprocity. No changes were observed in the patients’ companionship, practical and emotional support networks. During forensic psychiatric treatment, patients reported some new relationships, especially with persons outside the forensic psychiatric centre. Information on compositional and structural personal network factors over time helps forensic mental health professionals to properly assess and manage the important dynamic social network conditions associated with recidivism.     

Deceptive behaviour and instrumental violence among psychopathic and non-psychopathic violent forensic psychiatric patients

Deceptive behaviour and instrumental violence are well-known psychopathic features and as such play important roles in the assessment of psychopathy. This study examined first, the nature of the violence committed by offenders that have been admitted to forensic psychiatric care and whether scores on the Psychopathy Checklist: Screening Version (PCL:SV), Part 1, were associated with the instrumentality of violence. Second, we examined the proneness of offenders to re-frame the instrumentality in their past violent crimes, and whether this was associated with scores on the PCL:SV. The results show that the PCL:SV, Part 1 (interpersonal/affective features), was positively related to the officially coded instrumentality of the violent crimes. As expected, this association disappeared when the instrumentality was self-reported. However, the majority of the patients tended to exaggerate the reactivity of their violent crimes when it was self-reported, indicating that most offenders, independently of level of psychopathy, used deception when questioned about the characteristics of their past violent crimes. The reasons for, and implications of, the use of deception are discussed.     

35例性心理障碍的法医学鉴定分析

目的分析性心理障碍患者的医学和心理状况，总结该类案件的法医学鉴定体会。方法对35例经过调查取证、智力测验、MMPI测验的性心理障碍被鉴定人作回顾性分析。结果性心理障碍患者的智能多正常，存在不同程度的情绪和人格异常，以抑郁、强迫、焦虑、偏执、癔病、精神衰弱和病态人格为主；责任能力评定与被鉴定人的童年期性取向教育、恋爱经历、夫妻性关系、性心理障碍类型有关。结论性心理障碍患者发生特定犯罪行为的心理学机制不同于普通犯罪人群，评定责任能力不宜等同于正常犯罪。     

Alexithymia in Dutch violent forensic psychiatric outpatients

Abstract

Until now alexithymia has not been investigated in Dutch low-educated offenders who are known for their violent behaviour. We therefore investigated a sample of aggressive forensic psychiatric outpatients, who are characterized by emotional dysregulation in conflict situations. For that purpose we used a Dutch questionnaire, the Bermond-Vorst Alexithymia Questionnaire (BVAQ; Vorst & Bermond, 2001), which we also administered in a sample of secondary vocational students for a comparison. Unfortunately, the five-factor structure of the BVAQ could not be confirmed in both samples, but in the patient sample the test-retest reliability of the total score turned out to be moderate, and meaningful correlations were found with measures of relevant personality domains and problem behaviours. When both samples were compared, patients were found to display significantly higher total scores on the BVAQ than the secondary vocational students, when controlled for age. Therefore, we concluded that alexithymia may contribute to the aggressive behaviour of violent forensic psychiatric outpatients. However, patients as well as students had much higher total scores on the BVAQ than found by Vorst and Bermond (2001) in a sample of Dutch psychology students. This indicates that alexithymia as measured by the BVAQ is also inversely related to educational level and perhaps to intelligence.     

Profile of forensic state patients at a psychiatric unit in KwaZulu Natal,South Africa: demographic,clinical and forensic factors

State patients are mentally ill offenders whose charges involved serious offences. Research on association between psychiatric morbidity and offences is important however data from Southern Africa is limited. To examine the demographic, clinical and forensic characteristics of state patients, and to evaluate the determinants of offending by an investigation of the association between mental illness and other variables (offence, comorbidity). Retrospective record review of state patients admitted to a forensic unit in KwaZulu-Natal from the 1 June 2013 to the 31 May 2016. Most patients were male (n = 90, 98.90%), single (n = 89, 97.8%), unemployed (n = 89, 97.80%) and had a diagnosis of intellectual disability (n = 33, 36.26%). Majority of participants had comorbid diagnoses (n = 70, 76.92%) and most of them (n = 52, 57.14%) had substance use disorder. Forty (43.96%) patients had past forensic history and 18 (72.5%) were non-adherent with treatment. Offences were predominantly against persons (n = 80, 87.91%), and rape was the most common offence (n = 50, 54.95%). Findings regarding diagnosis and offence were not consistent with the literature and suggest the need to explore the differences further. A better understanding of the association between mental health and crime in resource restrained settings may assist in developing appropriate prevention and rehabilitation programmes.     

女精神病人的性防卫能力鉴定

目的　研究女性精神病人性防卫能力的特点和司法鉴定中应该注意的问题 ;方法　对过去 1 0年间鉴定过的 64例案例进行回顾总结 ;结果　性防卫能力丧失最常见于年轻的衰退期青春型精神分裂症病人、中度以上精神发育迟滞病人、首次发病的年轻轻型躁狂症病人 ,而其他类型的精神病人不容易发生性防卫能力丧失。结论　严重的智能障碍和情感障碍对于精神病人的性防卫能力的丧失有决定性作用 ;而且 ,病人对性行为的控制能力障碍对精神病人性防卫能力丧失有重要影响作用     

A prospective study of pathways to hospital readmission in Canadian forensic psychiatric patients

Individuals admitted to secure care often experience lengthy hospitalizations and are likely to be admitted on more than one occasion. In the context of growing demand and costs associated with secure care, the current study investigates the frequency and reasons for readmission among 87 forensic patients recently discharged into the community. We identify risk factors that are associated with the likelihood of readmission and describe areas of overlap and discordance with the existing literature in civil and forensic samples. Using a prospective design that included patient follow-up interviews and records review, we found that 28% of patients were readmitted on one or more occasions over a 12-month period. Psychiatric decompensation, substance use, and treatment non-adherence were the central reasons prompting readmission. Patients with one or more readmissions were found to have spent significantly more time in the forensic mental health system as compared to patients not readmitted. They were more likely to have a substance use disorder and were estimated to be at higher risk for violence. Results replicate the finding of low rates of serious violence and reoffending among discharged forensic patients, and substantiate the centrality of substance use as a growing and clinically important treatment issue.     

Psychiatric disorders and management of sexual offenders in the prison psychiatric consultation unit of Marseille

Since 2017, complaints of sexual violence have increased in France. At the same time, the management of sexual offenders has been at the center of international public health policies. The prevalence of mental disorders among sexual offenders is an essential field of research. There are some published studies on the prevalence of psychiatric disorders in sexual offenders in detention, but there are few recent published studies among French individuals who were detained. Our objectives were to determine the prevalence of psychiatric disorders among persons detained for sexual offenses and the level of care received according to their diagnosis. For this purpose, we carried out a retrospective observational study from January 2017 to October 2021 of all adult sexual offenders, whether accused or convicted, who were seen in the psychiatric consultation unit of Les Baumettes prison, Marseille, France. The primary outcome measure was the psychiatric diagnosis entered in the medical records. One hundred forty-two patients were included in analysis. All patients were men, and the majority (n = 97, 68.3%) of these patients presented with at least one psychiatric disorder, principally a personality disorder (31.7%). 10.6% presented with a schizophrenic disorder, 4.9% a bipolar disorder, 3.5% a depressive disorder, 5.6% pedophilic paraphilia, and 25.4% an addictive disorder. Their management and comorbid addictions were analyzed in subgroups for each psychiatric disorder. Patients appeared to receive an appropriate level of care for their diagnosed disorder. It seems important to develop structured assessment of recidivism risk for better management of sexual offenders.     

72例情感性精神障碍司法精神病鉴定分析

目的 探讨情感性精神障碍患者作案特征.方法 对杭州市公安局安康医院2000-2004年鉴定的72例情感性精神障碍案例进行分析.结果 情感性精神障碍患者作案与发作次数有一定关联性,躁狂症与抑郁症危害行为有统计学意义(P<0.01).情感性障碍患者作案特征与精神分裂症不同,主要是作案的病理性动机较少,现实动机较多.结论 反复发作是情感性精神障碍患者作案的预警性指标.在作案特征上与精神分裂症有各自不同的特点,可能与病因、病情发展、症状表现和严重程度等差异有关.     

道路交通事故所致精神损害的法医学评价

目的研究RTA所致PTSD的相关法医学问题,为司法实践中精神损害赔偿提供科学依据和司法建议。方法对156例因RTA申请伤残程度鉴定的被鉴定人,通过临床精神病学检查确定PTSD的诊断,法医临床学检查评定躯体损伤的伤残程度,并通过问卷调查进一步确定受害人的心理社会状态。结果156例被调查对象PTSD发生率为51.92%。男女PTSD的发生率具有统计学的显著性差异;随着伤残程度的严重性增加,发生PTSD的可能性也随着增加;PTSD组与非PTSD组在生活质量总均分和生理、心理、社会关系、环境四个维度以及焦虑、抑郁的各项得分中都有显著性差异;获得赔偿将明显降低PTSD的发生率。结论RTA作为创伤性事件,申请赔偿的RTA受害人存在较高的PTSD发生率,获得良好的赔偿可以明显地降低申请赔偿的RTA受害人PTSD的发生率。     

Ageing in forensic psychiatric secure settings: the views of members of staff

Background: Although the prevalence of older patients in forensic psychiatric services is increasing, research around service provision for this population is very limited. We aimed to gather the views of members of staff on how well secure services are meeting the challenges of an ageing population.

Methods: Three focus groups were carried out with 13 members of staff working with older patients in secure services. A topic guide, based on the research team’s previous research, guided the sessions. The focus groups were audio-recorded, transcribed and analysed through thematic analysis.

Results: Two themes were identified: (1) Identifying patients’ needs, which focused on how promptly any emerging issues in the older patients are identified and reported; (2) addressing patients’ needs, which focused on how the unique needs of the older patients are addressed, once established.

Conclusions: There are unique age-related issues that may have an impact on the older patients’ opportunities for recovery, including a lack of specialist training for members of staff, prolonged stay in secure care and a limited number of age-relevant activities. Far from optimal, provision requires improvement through the active involvement of the primary stakeholders.     

Adapting measures of social climate for use with individuals with intellectual developmental disability in forensic settings

The social climate of forensic settings is thought to impact on a number of important clinical and organisational outcomes and is, therefore, an important construct in relation to the successful functioning of forensic units. A variety of self-report questionnaires have been developed to objectively measure the social climate of forensic settings (e.g. the Correctional Institutions Environment Scale and the Essen Climate Evaluation Schema), however these questionnaires have not been validated for individuals with intellectual developmental disabilities (IDD). Given the prevalence of IDD in prison and forensic psychiatric settings and the potential impact of such cognitive deficits on the ability to complete a range of self-report questionnaires, it is important to consider the potential reliability and validity of existing social climate measures in IDD populations. This article will, therefore: (1) examine the cognitive, linguistic and response format difficulties that may arise when administering self-report measures of social climate in IDD populations; (2) consider potential adaptations to existing measures of social climate that might make them more suitable for use with IDD populations; and (3) identify important directions for future research in the area.     

The use of simulated crime scenes in teaching undergraduate forensic sciences: Implementing an active learning approach to forensics

Incorporating a simulated crime scene into one’s pedagogy in forensic science undergraduate courses allows students the opportunity to experience a realistic scenario while demonstrating their knowledge and enhancing their critical thinking skills. The purpose of this paper is to examine an active learning approach to using simulated crime scenes to provide an impactful learning experience for students. While potentially challenging for the instructor, constructing a crime scene scenario can provide students with hands-on practical experience while helping to dispel forensic science misconceptions. Through many years of creating crime scenes, best practices for using such high impact activities in forensic science courses are described in detail, including preparatory exercises that culminate in the final crime scene scenario, considerations in preparing and constructing a crime scene activity, and supervising and assessing students once the activity begins. Three major challenges to implementing active learning exercises such as simulated crime scenes in undergraduate forensic science programs include high workload for instructors, limited supplies, and lack of suitable facilities. Workload solutions include instructors and departments considering the cost and benefit of course releases to improve curriculum and student enrollment. Supplies and facilities solutions involve innovation in reuse and repurposing of supplies, and instructor flexibility in using classroom and outdoor spaces.     

The prevalence of violence and relation to depression and illicit drug use among incarcerated women in Recife, Brazil

PurposeTo assess the prevalence and different types of violence experienced by women prisoners in Brazil and the effects of violence on women's depression and illicit drug use.MethodsParticipants (N = 377) were incarcerated women from a state prison in a northeastern city of Brazil. Multivariate logistic regression models (adjusted for age, education, partner status, prison history, drug related offense, and sentencing status) were used to assess associations between each type of violence (physical abuse, sexual abuse, and life threats) and each outcome variable: recent depression and illicit drug use.ResultsThe majority of participants (87%) reported experiencing some type of violence in their lifetime, including physical violence (83%), sexual victimization (36%), and threats on their life (29%.) Sexual violence was significantly related to both recent depression (Odds Ratio (OR) = 2.8; 95% Confidence Interval (CI) = 1.4–5.3) and recent substance use (OR = 2.7; 95% CI = 1.6–4.4) in adjusted models. Experiences of life threats were also significantly associated with illicit drug use (OR = 2.2; 95% CI: 1.3–3.7), as was physical violence (OR = 2.4; 95% CI: 1.2–4.9); however, neither of these latter two violence variables were significantly associated with depression.ConclusionReports of lifetime violence victimization among this incarcerated sample of women were extremely prevalent and relevant to women's depression and illicit drug use. Prison efforts to address women's depression and illicit drug use may be most effective by incorporating aspects related to women's history of victimization, especially given the high rates of violence experienced by women in this sample.     

Forty-five revolutions per minute: a qualitative study of Hybrid Order use in forensic psychiatric practice

Psychiatrists who recommend a Hybrid Order (Section 45A) as a disposal option at the point of sentencing accept that the convicted individual, as well as being mentally disordered and in need of treatment, is also culpable and deserving of criminal punishment. Ethical and clinical concerns have typically limited its clinical use. However, in 2015 the Court of Appeal specified in R v Vowles and others that the Hybrid Order disposal should be considered first in terms of potential mental health disposals. This judgement sets a high threshold for the use of the hospital order which has been the bedrock of inpatient forensic psychiatric practice since 1983. This study sought to explore the attitudes of consultant forensic psychiatrists towards the use of the Hybrid Order in the wake of the Vowles judgement. We interviewed 12 consultant forensic psychiatrists with longstanding experience of psychiatric sentencing recommendations. We found that the majority of consultants considered the Hybrid Order to be a valuable disposal option when used under specific circumstances. However, significant concerns were raised about its use in those with an enduring psychotic illness. Community aftercare arrangements for Hybrid Order disposals were viewed as inferior to community aftercare arrangements for Section 37/41 patients.     

Reading level and the prevalence of a dyslexic profile among patients in a forensic psychiatric clinic

This study aims to investigate Swedish language reading ability of forensic patients and the number of them that present a dyslexia profile. Another aim is to compare the reading level in different subtypes of psychiatric diagnoses. Assessments were made of 185 patients by a battery of reading tests. They were also interviewed about their schooling and their self-estimated reading and writing ability. The results show that the patients’ reading level is below average for grade six children in Swedish compulsory school, and that 16 per cent show a dyslexic profile. Male patients with an immigrant background and a diagnosis of psychosis and anxiety disorders perform the lowest when measuring literacy skills. This proportionately low reading ability can cause difficulties in understanding texts as presented in broadsheet newspapers, civic information and patient records, and might even jeopardize the understanding of adult spoken language.