精神鉴定的评价范围——基于鉴定人与司法人员职权划分的思考

精神鉴定的评价范围涉及鉴定人与司法官的职权划分问题。在我国,精神鉴定的评价范围不仅包括医学要件与心理学要件,也包括刑事责任能力的内容,精神鉴定人通常都直接对刑事责任能力作出评定,此做法既与理论上的观点不一致,也与刑事诉讼法的规定不相吻合。较为合理的做法是由精神鉴定人对刑事责任能力的医学要件进行评定,心理学要件的判断则采用以司法人员为主、鉴定人为辅的合作方式。     

Traumatic Brain Injury among Indiana State Prisoners

Research on traumatic brain injury among inmates has focused on comparing the rate of traumatic brain injury among offenders to the general population, but also how best to screen for traumatic brain injury among this population. This study administered the short version of the Ohio State University Traumatic Brain Injury Identification Method to all male inmates admitted into Indiana state prisons were screened for a month (N = 831). Results indicate that 35.7% of the inmates reported experiencing a traumatic brain injury during their lifetime and that these inmates were more likely to have a psychiatric disorder and a prior period of incarceration than those without. Logistic regression analysis finds that a traumatic brain injury predicts the likelihood of prior incarceration net of age, race, education, and psychiatric disorder. This study suggests that brief instruments can be successfully implemented into prison screenings to help divert inmates into needed treatment.     

Forensic psychiatric units in Italy from the 1960s to the present

This article addresses the long-standing continuities in the history of the Italian forensic psychiatric units and views them as the result of conflicting forces, interests, mentalities and strategies at the cross-road of forensic psychiatry, psychiatry, prison and health services. It focuses on the period from the 1960s to the present and deals with, among other issues, the long-term impact of the anti-asylum movements and the on-going debate on the ‘phasing out’ of the forensic psychiatric units.     

Involuntary detention and treatment of the mentally ill: China's 2012 Mental Health Law

The long-awaited Mental Health Law of China was passed on 26 October 2012 and took effect on 1 May 2013. Being the first national legislation on mental health, it establishes a basic legal framework to regulate mental health practice and recognizes the fundamental rights of persons with mental disorders. This article focuses on the system of involuntary detention and treatment of the mentally ill under the new law, which is expected to prevent the so-called “Being misidentified as mentally disordered” cases in China. A systematic examination of the new system demonstrates that the Mental Health Law of China implicitly holds two problematic assumptions and does not provide adequate protection of the fundamental rights of the involuntary patients. Administrative enactments and further national legislative efforts are needed to remedy these flaws in the new law.     

Psychiatric Medication Intake in Suicide Victims: Gender Disparities and Implications for Suicide Prevention

Frequency and gender differences of psychiatric medication intake in a sample of suicide victims from the Athens Greater Area were investigated with a particular focus on the implications for suicide prevention. Data were collected from the toxicological analyses of the suicide cases of the period November 2007–October 2009. Information was available for 262 individuals, 196 men (74.8%) and 66 women (25.2%); 109 of these (41.6%) were receiving psychiatric medication(s). Women were statistically more frequently under treatment: antidepressants (32.8% vs. 11.3%, p < 0.001), antiepileptics (9.1% vs. 0.5%, p = 0.001), antipsychotics (24.2% vs. 9.2%, p = 0.003), and benzodiazepines (16.7% vs. 6.6%, p = 0.024). Campaigns aiming to bring men with psychological difficulties in contact with mental health services and to lessen the stigma of mental illness, together with better training of nonpsychiatrists into “suspecting” “male” depression, could be particularly helpful for decreasing male suicides. More thoughtful choice of psychiatric medication could possibly already prevent a number of female suicides.     

道路交通事故中脑外伤所致人格改变与精神伤残评定

目的探索道路交通事故中颅脑损伤所致轻度精神伤残者人格改变的主要表现形式及其在伤残评定中的价值。方法运用《脑外伤后人格改变评定量表》量化评定道路交通事故所致颅脑外伤者后遗人格改变状况,并探讨人格改变与颅脑损伤程度、精神伤残程度的相关性。结果 271例样本中239例(88.2%)存在人格改变,其中178例(65.7%)为轻度,46例(17.0%)为中度,15例(5.5%)为重度。人格改变程度在不同颅脑损伤程度之间的构成比差异无统计学意义(P0.05),但各组之间量表总分差异具有统计学意义(P0.05),两两比较显示中型与重型颅脑损伤之间差异无统计学意义。人格改变程度越明显,精神伤残等级越高,轻度精神伤残不同等级者人格改变评定量表总分差异具有统计学意义(P0.05),除七级与八级之间差异无统计学意义外,其余各组之间差异均具有统计学意义(P0.05)。结论交通事故中提出精神伤残评定的脑外伤者中人格改变发生比例较高,人格改变严重程度与精神伤残程度相关,《脑外伤后人格改变评定量表》能有效量化评定交通事故中脑外伤所致人格改变程度,量表总分与颅脑损伤程度具有相关性。     

Finding of Hyperostosis Frontalis Interna During the Autopsy Procedure: Forensic Issues

Hyperostosis frontalis interna is a common phenomenon, which may have been overrated in its significance in the past, and may, currently be underrated in its significance. We present three cases of hyperostosis frontalis interna found during medicolegal autopsies and discuss their forensic considerations. The patients were all middle‐aged women with metabolic and endocrine manifestations and psychiatric ailments; thickening of the inner table of the frontal bone of the skull was found during each autopsy. We describe the relationship between hyperostosis frontalis interna, metabolic manifestations, and neuropsychiatric symptoms as part of Morgagni‐Stewart‐Morel syndrome. There is still considerable disagreement in the scientific community as to whether this syndrome is a clinical entity. Nonetheless, awareness of Morgagni‐Stewart‐Morel syndrome can be of help in understanding the circumstances surrounding death. In some other cases, hyperostosis frontalis interna could be used by forensic pathologists as criteria for sexing and aging a skeleton.     

Stability of life-time psychiatric diagnoses among offenders in community and prison settings

The dearth of studies investigating diagnostic stability among offenders, and diagnostic stability being important from the patient’s mental health perspective, as well as from a public health, training and research standpoint, highlights the need to evaluate lifetime stability of ICD-10 psychiatric diagnoses for offenders in community and prison settings. A case-linkage design linked a two-year population-based cohort of male-sentenced prisoners with a state-wide psychiatric register (23,742 psychiatric consultations). Four measures of diagnostic stability were calculated for each setting as well as across settings, for all offenders who received at least two psychiatric diagnoses. Temporal consistency was moderate for schizophrenia spectrum disorders and low for affective, anxiety and personality disorders, and was higher in prison setting than community settings. Diagnostic instability highlights that the course of mental illness and clinical features among offenders may genuinely vary over time, across community and prison settings and may lead to complexities regarding psychiatric care for this population     

Violence prevention in psychiatry: an umbrella review of interventions in general and forensic psychiatry

Relative risks of violence in psychiatric patients are high compared to the general population and existing evidence in non-psychiatric populations may not translate to reductions in violence in psychiatric populations. We searched 10 databases including Medline, EMBASE, CINAHL and Scopus, from inception until August 2015 for systematic reviews and meta-analyses of violence prevention interventions in psychiatry. Reviews were included if they used a hard outcome measure (i.e. police or hospital recorded violence, or reincarceration) and contained randomized or non-randomized controlled studies. Five reviews met our inclusion criteria (n = 8876 patients in total), of which four received a GRADE rating of ‘low’ or ‘very low’. Three randomized studies (n = 636) reported that therapeutic community interventions may reduce reincarceration in drug-using offenders with co-occurring mental illness (‘moderate’ GRADE rating). The lack of intervention research in violence prevention in general and forensic psychiatry suggests that interventions from non-psychiatric populations may need to be relied upon.     

MAO基因遗传多态性及与精神疾病相关性研究进展

单胺氧化酶(monoamine oxidase,MAO)是调控儿茶酚胺和5-羟色胺等单胺类氧化脱氨的一类重要酶,广泛分布于包括神经系统在内的人体各种组织中,具有多种生物学功能。MAO有两种类型,MAO-A和MAO-B。MAO基因具有遗传多态性,其中部分多态性位点与某些精神疾病如严重抑郁障碍、酒精中毒、反社会情感障碍及精神分裂症等有一定的相关性。MAO基因遗传多态性的研究,可能为法医学个人识别与亲权鉴定提供新的遗传标记,并为司法精神病鉴定提供参考性遗传学指标。