限定刑事责任能力评定量表扩展应用的信效度

目的探讨限定刑事责任能力评定量表在责任能力评定中的扩展运用价值。方法采用DCRRS（内容包括现实作案动机,先兆,诱因,时间、地点、对象、工具选择,作案时情绪反应,作案后各种行为表现,生活自理能力、工作学习能力、自知力、现实检验能力损害和自我控制能力等）对108例符合要求的患者进行评定并与专家鉴定结果进行比较。结果DCRRS各条目间及其与总量表分间的相关均具有统计学意义（r=0.145～0.944,P〈0.001）,分半信度为0.868。根据DCRRS参考划界分分组,无、限定和完全责任能力3组间及两两间量表总分均具有显著统计学差异（P〈0.001）。DCRRS与专家鉴定结果一致性较高（Kappa=0.958,P〈0.001）,经判别方程回代具有较高的正确率（97.2%）。结论DCRRS的信效度良好,可作为辅助参考使用。     

The Relationship Between Mental Disorders and Types of Crime in Inmates in a Brazilian Prison

This cross‐sectional study conducted in prisons in the city of Salvador, Bahia, Brazil, investigated the association between the presence of psychiatric disorders in 462 prisoners and the types of crimes committed by them. Psychiatric diagnosis was obtained by means of the Brazilian Portuguese version of the Mini‐International Neuropsychiatric Interview. A statistically significant association was found between some psychiatric disorders and specific groups of crime: lifelong substance addiction with sex crimes and homicide; antisocial personality disorder with robbery and with kidnapping and extortion; borderline personality disorder with sex crimes; and lifelong alcohol addiction with fraud and conspiracy and with armed robbery and murder. It was concluded that the mental disorders considered more severe (psychosis and bipolar disorder) were not associated with violent crimes, suggesting that the severity of the psychotic disorder may be the factor that has caused psychosis to be associated with violent crimes in previous studies.     

Personality disorders and criminal responsibility in the Spanish supreme court

The aim of this study is to determine how personality disorders (PDs) are viewed in relation to criminal responsibility (CR) within the jurisprudence of the Spanish Supreme Court. All sentences with PD from 2000 to 2006 were included. The most frequently occurring PDs are cluster B and nonspecific disorders, alongside another Axis I disorder. The Spanish Supreme Court admitted appeals on 50%, and sentencing criteria were changed in 25% of the cases. The most frequent outcome was in the first instance a minor reduction in CR and second full CR being upheld. The borderline PD and the comorbidity between a PD and an Axis I disorder are the variables associated with the decrease in CR. The assessment of CR in PD should be undertaken using the diagnosis as a base taking into account other elements, such as the type of PD, its seriousness, comorbidity, and relationship with the criminal behavior on trial.     

Association for Methodology and Documentation in Psychiatry Profiles Predict Later Risk for Criminal Behavior and Violent Crimes in Former Inpatients with Affective Disorder*

Abstract: Few studies have investigated criminal and violent behavior in patients with affective disorders. We reviewed the national crime register for records of criminal offenses committed by 1561 patients with affective disorders and studied the predictive value of certain psychopathological symptoms assessed with the Association for Methodology and Documentation in Psychiatry (AMDP) system concerning future criminal behavior. Sixty‐five (4.2%) patients had been convicted in the 7–12 years after discharge (307 cases). Patients with the AMDP syndrome mania had a significantly higher risk for later criminal behavior. The combination with the hostility syndrome further increased the risk. These findings are in line with previous data indicating a higher risk for later criminal behavior in patients with a manic/bipolar disorder compared to depressive disorder. As previously demonstrated in another sample of schizophrenic patients, the AMDP syndromes mania (and hostility) is associated with a higher risk of later criminal behavior.     

伪装创伤后应激障碍的识别

创伤后应激障碍的鉴定是近年来司法精神病学实践中经常遇到的问题,其中如何识别诈病者也相应地成为业内人员关注的焦点之一。但是由于此障碍所涉及的创伤性事件多种多样,症状表现纷繁复杂,且信息来源主观性成分较大,同时又易有其他多种精神疾患与之共病,因而要作出完全正确的诊断或鉴定结论相当困难。本文通过对大量文献资料的归纳整理,分析了国内外在有关伪装创伤后应激障碍的表现特点、识别方法和测试手段等领域开展的研究现状,期望能为精神疾病司法鉴定中处理相关问题提供一定的帮助和参考。     

Among a German Sample of Forensic Patients,Previous Animal Abuse Mediates Between Psychopathy and Sadistic Actions

In an attempt to explain the relationship between psychopathy and severe violent behavior, this study associates previous animal abuse, psychopathy, and sadistic acting in forensic patients. Two topics are addressed: (i) whether previous animal abuse can be identified by a patient's Psychopathy Checklist profile and (ii) whether animal abuse statistically mediates between psychopathy and sadistic acting. In a German forensic hospital, 60 patients were investigated. Animal abuse was assessed using face‐to‐face interviews and the Psychopathy Checklist: Screening Version (PCL:SV), and sadistic acting was identified by file records.Discriminant analysis separated previous animal abuse (10/60) by high adolescent antisocial behavior, superficiality, lack of remorse, lack of empathy, and grandiosity. The mediation from psychopathy to sadistic acting (6/60) through animal abuse was found to be complete.The results, although sample size is limited and base rate of animal abuse and sadistic acting are low, fit with a model suggestive of animal abuse as a causal step toward sadistic crimes. Animal abuse correlates with callous, unemotional traits, and a development of sadistic crimes.     

Mental health weapons prohibition: demographic and psychiatric factors in petitions for relief

Federal law and most states prohibit possession of firearms by individuals with a history of certain psychiatric diagnoses and/or treatment. In California, an involuntary 72-h hold can trigger a 5-year ban on firearm possession. Individuals so prohibited may petition for early termination of the ban. We report on the demographic and psychiatric characteristics of a sample of individuals petitioning for early relief in Los Angeles County, and on the results of their petitions. The majority of petitioners were Caucasian men over age 40. Sixteen percent of petitioners were employed in law enforcement or armed security, and all of their petitions were granted. Individuals for whom there was greater evidence of mental disorder were significantly less likely to petition successfully. The results are discussed in terms of the benefits of involving a forensic expert in the petition process, which is not presently required under California law.     

Acute Influence of Alcohol,THC or Central Stimulants on Violent Suicide: A Swedish Population Study

Alcohol and substance abuse in general is a risk factor for suicide, but very little is known about the acute effect in relation to suicide method. Based on information from 18,894 medico‐legal death investigations, including toxicological findings and manner of death, did the present study investigate whether acute influence of alcohol, tetrahydrocannabinol (THC), or central stimulants (amphetamine and cocaine) was related to the use of a violent suicide method, in comparison with the nonviolent method self‐poisoning and alcohol‐/illicit drug‐negative suicide decedents. Multivariate analysis was conducted, and the results revealed that acute influence of THC was related to using the violent suicide method–– jumping from a height (RR 1.62; 95% CI 1.01–2.41). Alcohol intoxication was not related to any violent method, while the central stimulant‐positive suicide decedent had a higher, albeit not significant, risk of several violent methods. The study contributes with elucidating suicide methods in relation to acute intoxication.     

Malnutrition, a rare form of child abuse: diagnostic criteria

Infantile malnutrition is often difficult to diagnose as it is rarely observed in industrialized countries. It may be associated with physical violence or occur in isolation. The essential clinical sign is height and weight retardation, but malnutrition also causes a variety of internal and bone lesions, which lead to neuropsychological sequelae and death. We report a rare case of death by malnutrition in a female child aged 6 1/2 months. The infant presented height and weight growth retardation and internal lesions related to prolonged protein-energy malnutrition (fat and muscle wasting, thymic atrophy, liver steatosis) resulting in a picture of marasmus or kwashiorkor. We detail the positive and negative criteria that established the diagnosis of abuse, whereas the parents had claimed a simple dietary error.     

Examining gender as moderating the association between psychopathy and substance abuse

Previous research has shown a significant association between psychopathy and substance abuse. To date, these associations have not been compared between men and women in forensic or correctional samples, an important topic in light of some empirical findings indicating that psychopathy manifests differently across gender in other contexts. The current study was designed to address this gap in the literature using archival data sets consisting of four large samples derived from forensic, correctional, and university settings, with different measures for psychopathy, alcohol, and substance use. As expected, psychopathy (particularly traits reflective of disinhibition/social deviance) was significantly and moderately correlated with alcohol and substance abuse in all four samples; however, with one minor exception, hierarchical regression analyses revealed no significant moderating effects of gender on these associations. These findings indicate that, although psychopathy may be manifested differently across gender in some ways, substance abuse is likely not one of them.     

对邱兴华杀人案的司法鉴定学反思

关于邱兴华杀人案（下称邱案）的各种学术讨论和争论似乎已经不少，但查阅文献发现，有关邱案的文章，分别是从刑事诉讼法学、刑事证据学、刑事心理学、精神医学角度，法制新闻学以及从人权保护，法治进步等角度对该案进行解读。然而既然这是一个涉及司法鉴定的个案（虽然实际上并没有进行任何实质性鉴定活动），那么从司法鉴定学的角度对与该案有关的几个最基本的问题进行理论阐述，或许能有些许不同的作用。这几个问题包括：精神病概念的辨析，是否患病与是否需要接受刑事处罚之间是什么关系，何时需要启动司法精神医学鉴定？应如何配置我国刑事诉讼中的司法精神医学鉴定启动模式？     

Suicide behind bars: trends, inconsistencies, and practical implications

The results of two comprehensive approaches are compared: the nationwide surveys of suicides in U.S. jails by Hayes and the international meta-analyses of suicides in jails and prisons by Fazel et al. Factors are classified as demographic, situational, clinical, and methodical. More than 50% of U.S. jail suicide victims were men, white, unmarried, under 28 years of age, charged with minor or drug-related offenses, and intoxicated with drugs or alcohol. Suicides significantly occurred in isolation. Suicide victims in the international study were significantly (p < 0.001) men, white, married, pretrial, and charged with or convicted of violent offenses. Psychiatric diagnosis, alcohol abuse, taking psychotropic medication, and suicidal ideation were also positively correlated in the international study, but suicide victims were distributed more evenly over age-groups. Results of other studies illustrate the near universality of some findings. Three theories of suicide are briefly discussed.     

The Value of Crime Scene and Site Visitation by Forensic Psychologists and Psychiatrists

Site visits and crime scene visitation by forensic psychologists and psychiatrists may enhance the accuracy and credibility of their forensic work in criminal, civil, and other important contexts. This ethically sound technique of after‐the‐fact data collection and verification offers numerous potential benefits to the forensic mental health professional: clarifying the subject's actions, assessing the reliability of witness reports, identifying contextual determinants of behavior, and more fully illuminating subject motivation and decision‐making. Limitations and suggested guidelines for conducting site visits are offered. Guidelines include preplanning, arranging for an informed guide to accompany and narrate the visit, and conducting the site visit prior to forensic examinations.     

105例凶杀案责任能力评定分析

目的探讨鉴定医生评定凶杀案例责任能力时的主要依据及影响因素。方法对总计105例凶杀案的精神病司法鉴定案例进行回顾性分析。结果无责任能力者41例(39.0%);限定责任能力者28例(26.7%);完全责任能力者36例(34.3%);与刑事责任能力的评定密切相关的因素有:凶杀行为是否由精神病理因素引起(Gamma=0.906,P=0.000),临床诊断是否为重性精神病(Gamma=0.761,P=0.000),被害人是否为家人亲属(Gamma=0.412,P=0.000)。结论从技术层面看,鉴定医生评价责任能力考虑的三个主要方面按重要性依次是:凶杀行为是否由精神病理因素引起,被鉴定人是否患有重性精神病,被害对象是否为家人亲属。     

刑事责任能力评定中“待分类的精神病性障碍”的诊断分析

目的探讨"待分类的精神病性障碍"诊断在刑事责任能力鉴定中的形成原因、判定原则及处理措施。方法分析比较四川西南司法鉴定中心2006年1月至2007年7月刑事责任能力鉴定案例中12例诊断为"待分类的精神病性障碍"的鉴定资料。结果形成此诊断的主要原因是鉴定资料不充分,描述的被鉴定人精神异常表现不具体、不典型(83.3%),或鉴定资料描述的精神异常与鉴定检查时发现的情况不一致。但是即使诊断为"待分类的精神病性障碍",仍可以从作案动机、有无逃逸等评定其刑事责任能力。12例诊断为"待分类的精神病性障碍"的被鉴定人9例(75%)判定为具有限制刑事责任能力,3例(25%)判定为无刑事责任能力。结论"待分类的精神病性障碍"是一种暂时性诊断,在一定程度上可以在司法精神病鉴定中使用,但应慎用。     

The presence of low IQ and mental retardation among murder defendants referred for pretrial evaluation

After an overview of definitions of mental retardation and recent case law regarding mental retardation and the death penalty, this paper presents a study of factors associated with a mental retardation (MR) diagnosis among murder defendants. Subjects with a full-scale IQ< or =70 (n=42) were compared with other pretrial murder defendants (n=228) referred for forensic evaluation over a 5-year period. Subjects with an IQ< or =70 who were diagnosed with MR were compared with subjects with an IQ< or =70 who did not receive this diagnosis. Female murder defendants were more likely to receive a diagnosis of MR (p=0.03). MR was also more commonly diagnosed in subjects with an Axis I cognitive disorder (p=0.018). Having an IQ< or =70 was more common in subjects with a psychotic and substance use disorder (p=0.03) and did not necessarily lead to a diagnosis of MR in this subgroup. Implications for diagnosing MR among murder defendants are discussed.     

Child Sexual Abuse Perpetrated by Women: Case Series and Review of the Literature

The literature on child sexual abuse (CSA) perpetrated by female sexual offenders (FSOs) is exiguous, and many studies have focused on judicial databases. The present retrospective study, instead, analyzed clinical and judicial data of a group of both victims and alleged FSOs, to additionally include women who have not been convicted by the criminal justice system, but who hold strong clinical suspicions of being perpetrators of CSA. The medical records and the Court files of 11 children and their eight suspected FSOs have been collected and critically reviewed in light of the literature to date. This approach allowed for a deeper understanding of the relationship between child and FSO. The authors hypothesize that the victims’ severe psychopathological outcomes were a result of a failure to develop appropriate attachments with their prospective caregivers, which could have been damaged by the pathological relationship with FSOs, who were the victims’ caregivers.     

Child abuse: practical application of autopsy, radiological, and microscopic studies

A 17-month-old male infant died at home. The infant's right arm was immobilized because of a humeral fracture 1 month earlier. The circumstances of death appeared unclear to the police investigators and a medicolegal autopsy was carried out. External examination revealed diffuse ecchymoses of varying color. Postmortem imaging was performed prior to autopsy (X-rays, multislice computed tomography [MSCT], and focused brain magnetic resonance imaging [MRI]). These investigations revealed four rib fractures of varying ages, one of which was posterior. Cerebral and pericerebral traumatic lesions were also diagnosed: bilateral subdural hematomas, intraventricular, meningeal, and interpedoncular hemorrhages. In the abdomen, fresh blood was visible within the anterior abdominal wall and the mesenteric root. Autopsy and microscopic study confirmed these lesions. This case report illustrates the valuable assistance rendered by MSCT and MRI to diagnose abuse when a child has died in unclear circumstances.     

Elderly sexual offenders: two unusual cases*

The aim of this case report is to describe two cases of sexual abuse by elderly subjects for which the Judge commissioned an expert psychiatric-forensic opinion. The elderly are generally believed to commit nonviolent crimes, whereas the two cases we observed feature forcible rape committed by elderly offenders, who showed no form of mental disease and had rationally planned their offense. They had never previously committed similar acts and had no history of homosexuality; both had been married for many years before the death of their wives and had adult children. Finally, no previous episodes of rape emerged in their personal histories during interrogations. The sociocultural context in which the crimes were committed was identical and arouses interest as regards both the method employed and how the crimes were discovered. The legal authorities then commissioned accurate investigations including medicolegal and psychiatric-forensic evaluations of the offenders and their victims.