41例具有危害行为的精神发育迟滞者司法精神病鉴定分析

目的　探讨精神发育迟滞者发生危害行为的相关因素。　方法　对 1992至 2 0 0 1年司法精神病鉴定为精神发育迟滞的危害行为人 41例进行分析。　结果　精神发育迟滞者发生危害行为的以盗窃占首位 ,凶杀、纵火次之 ,多见于家庭监护能力差、明显受社会歧视的 30岁以下的未婚青年男性。　结论　精神发育迟滞者引起违法行为是社会不安定的因素之一 ,应尽快建立健全相关的法律法规 ,确实加强监护、管理。     

精神卫生法的理想与现实

《精神卫生法》的立法经历了一个极其漫长的过程,最终出台的法律文本仍然存在非常严重的问题,其立法所要解决的问题所要达到的目的非常高,而与中国的现实严重脱节。《精神卫生法》立法的三大理想中,保护精神病患者的合法权益是核心,并希望立法来解决包括被精神病等一系列的社会现实问题。但是,立法脱离现实,相关的内容甚至出现了错误,表现在精神病患者的收治、实施导致人体器官丧失功能的外科手术、急诊急救、基层医疗机构的精神卫生保障等方面。由于存在不切合中国实际国情的规定,《精神卫生法》在我国的实施将会大打折扣。建议《精神卫生法》重点关注严重精神疾病患者得不到治疗、肇事肇祸的严重精神疾病患者得不到强制医疗的现象,关注财政投入不足、强制收治不规范等方面的问题。     

论纯粹精神损害赔偿

纯粹精神损害是指自然人于其民事权利未受侵害情况下遭受的精神利益损害。在受害人利益保护日益受到重视的大趋势下,纯粹精神利益损害赔偿成为各国精神损害赔偿制度难以回避的理论难题。纯粹精神损害存在两种类型:可推知的纯粹精神损害和可证实的纯粹精神损害。侵权责任法规定人身利益损害可以要求精神损害赔偿,意义重大,但应采取审慎的态度,建立多重限制规则避免纯粹精神损害赔偿的滥疡。     

再议毒品所致精神障碍者的刑事责任能力评定

我国法律未规定毒品所致精神障碍者的刑事责任问题,国内法学界和司法精神病学界对此问题争论的焦点主要集中在吸毒者陷于辨认或控制能力丧失状态下实施危害行为时该如何评定其刑事责任能力上。毒品所致精神障碍者的刑事责任能力评定应从法律的角度来探讨,而不能由司法鉴定人员以精神病学的角度来认定有无刑事责任能力。     

Antecedents and Consequences of Psychiatric Disorders in African-American Adolescents

This study included three waves of data, collected from approximately 890 African-American children and their families. Antecedents and consequences of psychiatric disorders among this population were examined. Children’s temperament, pubertal timing, and experience of stressful life events were tested as antecedents of psychiatric disorders. Several aspects of school functioning were then tested as consequences of psychiatric disorders. In addition, children with a single psychiatric disorder and those with comorbid disorders were statistically compared. Results showed that (1) children with at least one disorder, compared to those with no disorder, exhibited significantly more difficult temperament, experienced puberty earlier, and underwent greater numbers of stressful life events; (2) those with at least one disorder had significantly poorer school outcomes than those with no disorder; (3) children with comorbid disorders, compared with those who had only one disorder, displayed lower educational aspirations and poorer school commitment.

Overriding Psychiatric Advance Directives: Factors Associated with Psychiatrists' Decisions to Preempt Patients' Advance Refusal of Hospitalization and Medication

Psychiatric advance directives (PADs) are intended to support patients' treatment decisions during a crisis. However, PAD statutes give clinicians broad discretion over whether to carry out patients' advance instructions. This study uses data from a survey of psychiatrists (N=164) to examine reasons for overriding PADs. In response to a hypothetical vignette, 47% of psychiatrists indicated that they would override a valid, competently-executed PAD that refused hospitalization and medication. PAD override was more likely among psychiatrists who worked in hospital emergency departments; those who were concerned about patients' violence risk and lack of insight; and those who were legally defensive. PAD override was less likely among participants who believed that involuntary treatment is largely unnecessary in a high-quality mental health system.     

Attitudes among medical and law students toward decision-making in regard to involuntary psychiatric hospitalization

Background

The management of individuals with mental illnesses sometimes requires involuntary hospitalization. The Israel Mental Health Act requires that cases of involuntary psychiatric hospitalization (IPH) be periodically reviewed by the district psychiatric committee. The discussion in the committee often leads to debate regarding the need for an IPH potentially depriving the patient of his freedom. Little is known about the way in which the psychiatrists and attorneys on these committees arrive at their decisions. The present study was designed to examine the views of future doctors and attorneys concerning cases of possible IPH to determine whether their decisions would be influenced by their respective professional educational backgrounds.

Methods

After compiling demographic data, we asked 170 students from each of the two disciplines what their decision would be in two hypothetical cases that dealt with the question of a prolongation of a psychiatric hospitalization. Questionnaires examining social distance and possible stigmatizing views concerning psychiatric patients were also distributed and collected.

Results

The response rates for the medical and law students were, respectively, 90% and 85%. We found no differences between the medical and law students regarding their views on prolongation of a psychiatric hospitalization. This was consistent regardless of whether the hospitalization was against the patient's will or according to his wish and against the treating physicians' advice. We also found that the medical and law students had similar general views regarding psychiatric patients, but that the latter evidenced greater social distance than the former.

Conclusions

Academic background and socialization were not found to influence the decisions of students regarding IPH. Educational programs and exposure to psychiatric patients during law studies are proposed to lessen psychiatric stigma and promote better understanding between members of the two disciplines.     

Mentally ill offenders in prison: the Belgian case

According to the EUPRIS-study on mental health in prisons (2007), available data on mental disorders in prison are scarce. Therefore, this study aims at summarizing and discussing the available knowledge on incarcerated mentally ill offenders concerning: (1) the screening and assessment for detecting mental health; (2) the psychiatric expertise in order to evaluate the mental status; and (3) the development and provision of forensic psychiatric treatment and care. These findings will be applied to the current situation in Belgium, which is a particularly interesting case. Belgium is currently facing difficulties concerning a large population of interned mentally ill offenders residing in correctional establishments.Implications with regard to the penal code, general or mental health legislation, screening, assessment, and treatment could deliver interesting viewpoints on how this problem could be tackled more effectively. Therefore, the findings will be discussed with reference to the international scientific and policy debate, focusing on ethical implications.     

Mental Illness and Legal Fitness (Competence) to Stand Trial in New York State: Expert Opinion and Criminal Defendants' Psychiatric Symptoms,

Fitness to Stand Trial is a critical concept in the adjudication of justice‐involved persons. A retrospective study was conducted to examine criminal defendants' specific psychiatric symptoms and those symptoms' associations with expert opinions on Competence to Stand Trial. One hundred charts were reviewed: 50 Cases (opined as Not Fit) were compared against 50 Controls (opined as Fit) with respect to ratings on the Brief Psychiatric Rating Scale (BPRS). A significance level of 0.001 was selected a priori. Statistically significant differences were found in seven of the eighteen BPRS symptom constructs (with the highest differences in Conceptual Disorganization and Unusual Thought Content) and two of the four BPRS higher‐order syndrome factors (Thinking Disorder and Hostile‐Suspiciousness). Consistent with previous reports, psychotic symptoms are found in this study to be inversely associated with Fitness. Validity, reliability, and limitations of this study, as well as directions for future research, are discussed herein.     

精神障碍患者约束和隔离措施的法律规制

约束和隔离是严重剥夺精神障碍患者人身自由的强制措施。约束和隔离实施中所存在的非人道性、危险性和负面效果使得该措施饱受争议,因而法律只允许在例外情况下使用约束和隔离措施,并对其实施条件和程序予以严格限制。即,在实体上明确约束和隔离措施的适用条件和情形,在程序上明确约束和隔离措施的实施步骤,从而构筑起约束、隔离的法律规制体系。