Stalking behavior in delusional jealousy

Stalking behavior has been associated with several mental disorders, both psychotic and non-psychotic. The most frequently associated condition appears to be an individual with primitive personality psychopathology regardless of co-occurring psychotic symptomatology. Among the psychotic symptoms, erotomanic, and jealousy delusions may be the most clinically and torensically relevant. However, delusional jealousy has not been well appreciated in the psychiatric literature as an important contributor to stalking behavior. In this article, we explore the psychiatric, psychosocial, and forensic aspects of stalking in the context of delusional jealousy. We use a case example to highlight important issues in this area.     

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。     

精神病人辨认能力和控制能力的多因素分析

目的探讨更科学、客观地评定辨认能力和控制能力的方法。方法对239例刑事责任能力评定案件资料进行相关分析和逐步判别分析,筛选出对辨认能力和控制能力评定有重要影响的判别因子。结果辨认能力与控制能力的判别因子稍有差异,但与责任能力三者之间高度相关;精神科诊断、作案现实动机、作案对象选择性、作案后逃避责任、生活自理能力损害、现实检验能力损害为辨认能力的判别因子;精神科诊断、作案现实动机、作案前先兆、作案对象选择性、作案后逃避责任、工作学习能力的损害、自知力损害、现实检验能力损害、自我控制能力损害为控制能力的判别因子;建立的辨认能力和控制能力的判别方程经组内、组外考核有较高的正确率。结论辨认能力和控制能力判定的多元方程有较好的实用价值,有助于提高鉴定结论的一致性。     

精神病人刑事责任能力影响因素研究

目的研究精神病人刑事责任能力影响因素。方法用湖南医科大学精神卫生研究所编制的精神病人责任能力评定量表,对司法部司法鉴定中心2001年鉴定的159例刑事责任能力评定案件进行回顾性资料分析。结果该量表的绝大多数条目在不同责任能力组差异均达统计学显著性水平,对作案行为的罪错性认识、作案现实动机、自我控制能力损害、自知力损害、作案时间选择性、现实检验能力损害、生活自理能力损害、工作或学习能力损害等是影响其辨认能力和控制能力的主要因素,以对作案行为的罪错性认识、作案现实动机、自知力损害等因素更为明显。结论责任能力评定量表可为精神病人责任能力评定提供相对可靠的客观依据。     

Evaluation of a cognitive-behavioral program for chronically psychotic forensic inpatients

The present study evaluated the progress of four groups of chronically psychotic patients in treatment at De Kijvelanden Forensic Psychiatric Hospital. The psychotic patients were offered a cognitive-behavioral program, including psycho education, grief processing, stress management, functional training, coping with psychotic symptoms (Liberman module) and social skills training. Nine patients dropped out of the program. Sixteen patients who completed it scored significantly better than a control group of 16 psychotic patients, who had not yet participated in the program, on the "social skills" and "negative coping behavior" subscales of one of two observation scales used. On the other observation instrument (REHAB), however, no significant improvement in the general level of functioning was found in the group of treated patients, as compared to the control group. Apart from these two observation scales, the PANSS (structured interview for positive, negative and general psychopathological symptoms) and the SIG (self-report questionnaire for social anxiety and social responses) were used to evaluate treatment progress. Significant improvements were not found on these scales, except for a slight positive effect on the PANSS negative symptoms scale. These results illustrate the difficulties and limitations of treating chronically psychotic offenders, who often also suffer from cluster B personality disorders.     

Correlative Factors for Organic Psychotic Symptoms in Patients Following Traumatic Brain Injury

Objective To investigate the correlative factors for organic psychotic symptoms following trau matic brain injury （TBI）. Methods In the current study, 391 subjects who had undergone forensic iden tification of the organic mental disorders due to TBI were included, both the demographic and posttrau matic information collected. The relevant data were statistically analyzed in those confirmed as organic psychotic syndrome according to Chinese Classification of Mental Disorders 3rd version （CCMD3）. Re suits Fiftytwo subjects （13.3%） were identified as organic psychotic symptoms. The chisquare test showed that the detectable organic psychotic symptoms were associated with the marriage status, damage nature, injury severity and treatment, and the multivariate logistic regression analysis revealed good fitness of treatment and injury severity with the regression model （OR=0.044, 95% CI： 0.0170.114; OR=2.145, 95% CI： 1.201-3.832, respectively）. Conclusion The risks of organic psychotic symptoms following TBI can be involved in the alternative of craniotomy for the cases with trauma and moderate brain injury.     

A 24-Year Follow-up Study on Recidivism in Male Mentally Disordered Sexual Offenders With and Without Psychotic Disorders

There is a lack of knowledge on mentally disordered sex offenders (MDSOs) targeting adult victims, especially regarding recidivism patterns and the specific subgroup with psychiatric disorders. This paper presents index offense data, clinical data, and recidivism patterns over up to 24 years in a cohort of 146 MDSOs, with and without psychotic disorders, sentenced in Sweden between 1993 and 1997. At the time of the offense, all offenders were affected by clinical, developmental, and criminal history factors. MDSOs with psychotic disorders only marginally differed from those without, the former being less likely to have been institutionalized during childhood, intoxicated during the index offense, or diagnosed with a personality disorder, substance use disorder, or paraphilic disorder. In the cohort, 3.4% of the MDSOs were reconvicted for a new sex offense over 2 years, 9.6% over 5 years, 13.0% over 10 years, and 17.1% over the entire follow-up period of 24 years. In MDSOs with psychotic disorders, no subjects were reconvicted during the first 2 years, while 2.6% were reconvicted over 5 years, 5.3% over 10 years, and 7.9% over 24 years. Recidivism rates for violent and general reoffenses were 39.0% and 37.7%, respectively, for the cohort of MDSOs, and subjects with psychotic disorders reoffended significantly later in general offenses. In conclusion, MDSOs with psychotic disorders showed the same recidivism pattern as MDSOs without psychotic disorders. Furthermore, recidivism research may preferably focus on follow-up periods of 5–10 years since most offenders appear to recidivate within this timeframe.     

A case of Munchausen syndrome by proxy with subsequent stalking behavior

A case of Munchausen syndrome by proxy (factitious disorder by proxy) wherein the patient presented with symptoms of severe borderline personality disorder and questionable psychotic symptoms is discussed. This patient was also adjudicated for harassing and stalking a child protective services worker assigned to her case. Issues pertaining to possible feigning of psychotic symptoms were addressed in her inpatient treatment. Despite doubts concerning the veracity of some of her psychotic symptoms, the patient responded well to clozapine, and she was subsequently able to stay out of the psychiatric hospital for longer periods and make a reasonably good adjustment to living in a group home. After refusing to continue with clozapine therapy because of weight gain concerns, her adjustment declined.     

Post-Hinckley insanity reform in Oregon

The 1983 Oregon legislature responded to public pressure to narrow the application of the insanity defense by eliminating personality disordered individuals from consideration for an insanity verdict. This article examined the effects of the statutory change, and found no significant change in the frequency of insanity acquittals of personality disordered subjects between the three pre-reform years (n = 21) and the three post-reform years (n = 14). We also reviewed how the Psychiatric Security Review Board handled these patients once committed to their jurisdiction. We constructed a matched comparison group of psychotic acquittees and found that in the pre-reform years the personality disordered subjects spent less time in the system and less time in the hospital than the psychotic patients. However, in the post-reform years their time in the system and time in the hospital was the same as the psychotic controls. There were fewer decisions to discharge personality disordered patients from the system after the reform, although this difference may be due to factors other than the statutory reform itself. The conclusion is that narrowing the insanity defense is a worthy goal which may be difficult to achieve.     

Prepartum Psychosis and Neonaticide: Rare Case Study and Forensic‐Psychiatric Synthesis of Literature

Peripartum psychosis is a rare but serious psychiatric disorder characterized by the presence of a mood episode with psychotic features. Although controversy surrounds the nosological status of peripartum mental disorders, these conditions continue to be of exceptional interest to the medical and forensic mental health communities. The aim of this study was to report a rare case of prepartum psychosis which escalated to the endpoint of neonaticide and summarize literature on peripartum mental disorders and infanticide. A 30‐year‐old mother murdered her newborn with the spike of her serum delivery system and planned to commit suicide while in hospital after hallucinating due to an acute puerperal psychotic disorder with a prepartum onset and postpartum deterioration. Her disorder was not managed until neonaticide. Throughout this paper, the significance of a multidisciplinary approach for the optimal management of these incidents is highlighted and diagnostic as well as therapeutic issues are addressed.     

Behavior on the ward of personality-disordered inpatients and chronically psychotic inpatients during a three-year stay in a Dutch forensic psychiatric hospital

To gain insight into the behavior of a group of personality-disordered patients and a group of chronically psychotic patients during their stay in a Dutch forensic psychiatric hospital, data on these patients were collected biannually for seven years. Three aspects of the patients’ behavior were examined: the prediction of institutional behavior shortly after admission, changes in the patients’ behavior on the ward during their stay in hospital, and the prediction of these changes. In the personality-disordered patients, observed irritation/anger and aggressive behavior on the ward turned out to be positively related to psychopathy, the PCL-R lifestyle and antisocial facets, and the neuroticism domain. A positive relationship was also found between aggressive behavior on the ward and trait anger. In the chronically psychotic patients, a positive relationship was found between irritation/anger and the PCL-R interpersonal and lifestyle facet. During a stay of three years, the aggressive behavior of both patient subgroups, which was already low at the start, did not decrease further, but their prosocial behavior increased. In the personality-disordered patients, relatively high scores on the antisocial facet of the PCL-R indicated an increase in prosocial behavior, whereas in the chronically psychotic patients no relationship was found between any PCL-R facet and behavior change. Effect studies on treatment programs for forensic psychiatric inpatients have to contend with the problem of a low base rate of institutional aggression. Therefore, we advise that such studies focus not only on a decrease in negative behaviors but also on an increase in positive behaviors.     

Severe Mental Illness,Somatic Delusions,and Attempted Mass Murder

A case of an attempted mass shooting at a large psychiatric hospital in the United States by a 30‐year‐old male with severe mental illness, somatic delusions, and exceptional access to healthcare professionals is reported. Six persons were shot, one died at the scene, and the shooter was then killed by the police. Data were gathered from court documents and media accounts. An analysis of the shooter's psychiatric history, his interactions with healthcare professionals, and communications prior to the shooting suggest a rare form of mass murder, a random attack by a documented psychotic and delusional individual suffering with somatic delusions. Despite his being psychotic, the killer planned the attack and made a direct threat 1 month prior to the shootings. This case highlights problems with the healthcare system, indicating that it might be ill equipped to appropriately deal with severe mental illness.     

Rhabdomyolysis following violent behavior and coma

An individual suspected of being under the influence of phencyclidine (PCP) exhibited acute psychotic and violent behavior which was followed by cardiac arrest, coma, and renal failure. Sections of the damaged muscle showed rhabdomyolysis, and sections of the kidneys showed myoglonin casts positive for immunoperoxidase stain. Extensive toxicology studies for narcotics, PCP, and cocaine were negative. Therefore, a correlation between PCP and rhabdomyolysis associated with acute psychotic and violent behavior could not be made with certainty. The etiology and pathogenesis of rhabdomyolysis are discussed in depth.     

Psychotic versus non-psychotic firesetters: similarities and differences in characteristics

Firesetters with psychotic disorders constitute a distinct and important offender group. However, little is known about how psychotic firesetters differ from non-psychotic firesetters. More knowledge is required in order to treat this particular population effectively. Psychotic (n?=?30) and non-psychotic (n?=?94) firesetters of both sexes referred for pre-trial forensic mental health assessment in the Netherlands were compared on socio-demographic, pathological, judicial and event-related characteristics using binary and multivariate statistical tests. Results showed that psychotic firesetters were older, single and unemployed. They had a more extensive history of mental health problems, associated drug use and impaired self-reliance. Opposed to non-psychotic offenders, physical abuse in childhood and alcohol abuse were less prevalent. They had a more extensive history of prior convictions, committed the arsons more often alone and were less often intoxicated. Treatment implications are discussed as focusing treatment on these differences may contribute to treatment efficacy and prevention of recidivism.     

Prisoners with psychosis in England and Wales: diversion to psychiatric inpatient services?

The prevalence of psychosis among prisoners in England and Wales is ten times that in the household population and UK government policy is that prisoners should receive equivalent care to those in the community. This study investigated the implications of policy to divert more from the criminal justice system for psychiatric treatment. Psychotic prisoners were compared with psychotic persons in households and with other prisoners in two surveys of psychiatric morbidity in representative samples of the UK population. Psychotic prisoners were younger, more from ethnic minorities, with comorbid anxiety, substance misuse, ASPD, and childhood behavioural problems compared to psychotic persons in households. Less than a third had received previous inpatient treatment. Psychotic prisoners had similar criminal histories and higher psychopathy scores than non-psychopathic prisoners. Diversion is unfeasible without improved screening for psychosis and increasing bed numbers at higher levels of security to accommodate more patients who would pose high risk to the public. Future research should investigate why UK psychiatric services fail to identify psychotic prisoners and provide aftercare.     

Clinical and demographic characteristics of elderly offenders at a maximum-security forensic hospital

The purpose of the study was to determine the clinical and demographic characteristics of the male elderly offenders admitted to a maximum-security forensic hospital. Charts of male elderly patients were reviewed to obtain clinical and demographic data. Seventy-seven percent of geriatric felons were involved in violent crime, 41% of which had psychotic symptoms. Forty-five percent of offenders with a history of head trauma/neurologic disorder were charged with violent offenses. Fifty-nine percent had previous psychiatric hospitalization. Most elderly male offenders involved in violent crimes had primary psychotic and mood disorders, cognitive impairment, and a history of head trauma/neurologic disorder. The small number of subjects precludes clear conclusions and needs further study.     

精神病人凶杀案的作案特征与刑事责任能力问题

探讨精神病人杀人的作案特征与刑事责任能力问题。以精神病人 ( 74例 )与非精神病人 ( 77例 )的案例资料进行对照研究。精神病人杀人具有突发性、公开性、残忍性 ;妄想 ( 4 7 2 % )、幻听 ( 31 3 % )是其促发杀人的主要危险因素 ;犯案以精神分裂症居首位 ( 4 0 5 % ) ,其次是躁狂抑郁症 ( 14 8% )。作案特征与作案动机是精神病人凶杀案刑事责任能力鉴定的重要依据     

Psychopathic traits in Finnish homicide offenders with schizophrenia

There is a paucity of studies examining psychopathy in comparable samples of violent individuals with and without psychotic illness. The main goal of the study was to assess the prevalence and nature of psychopathic traits as measured by PCL-R among Finnish homicide offenders with schizophrenia. Further, the impact of co-morbid psychopathy on the homicidal incidents, as well as the associations of psychopathy and offender background factors, among offenders with schizophrenia was investigated.A retrospective study was performed using extensive forensic psychiatric evaluation reports and crime reports as sources of information. The sample consisted of 72 homicide offenders with schizophrenia and 72 controls without psychotic illness.Psychopathic features were prevalent among Finnish homicide offenders with schizophrenia, although for the most parts to a lesser extent compared to other homicide offenders. Like non-mentally ill psychopathic offenders, offenders with schizophrenia and many psychopathic traits are likely to present early starting problems in many areas of life and they also commit homicides that resemble other psychopathic offenders' in their choice of victims, intoxication and post-offense behavior.The observed prevalence of psychopathic traits highlights the importance of psychopathy assessment among violence-prone individuals with schizophrenia. In most respects, offenders with schizophrenia and high levels of psychopathic traits seem to be similar to psychopathic offenders without psychotic illness, which has implications for early intervention and management.     

Relationships between legal and clinical factors among forensic hospital patients

Recognizing that established relationships enhance understanding and therefore improve clinical intuition and inference, the authors examined clinical and legal characteristics of a legally and clinically heterogeneous population of maximum security forensic hospital patients (n = 380). Several findings serve to substantiate outcomes of previous studies of subgroups of offenders. Some new relationships among legal and clinical variables are established. The relationship between admission legal status and Axis I diagnosis is dependent upon the Axis II diagnosis. Those admitted for competency evaluations have the lowest percentage of psychotic diagnoses and the highest IQ. Kidnapers have the highest percentage of psychotic diagnoses and there is a relationship between previous incarceration and drug treatment refusal. The authors discuss clinical implications, generalizability, and the needs for further investigation.