Listening to voices: The use of phenomenology to differentiate malingered from genuine auditory verbal hallucinations

The experience of hearing a voice in the absence of an appropriate external stimulus, formally termed an auditory verbal hallucination (AVH), may be malingered for reasons such as personal financial gain, or, in criminal cases, to attempt a plea of not guilty by reason of insanity. An accurate knowledge of the phenomenology of AVHs is central to assessing the veracity of claims to such experiences. We begin by demonstrating that some contemporary criminal cases still employ inaccurate conceptions of the phenomenology of AVHs to assess defendants' claims. The phenomenology of genuine, malingered, and atypical AVHs is then examined. We argue that, due to the heterogeneity of AVHs, the use of typical properties of AVHs as a yardstick against which to evaluate the veracity of a defendant's claims is likely to be less effective than the accumulation of instances of defendants endorsing statements of atypical features of AVHs. We identify steps towards the development of a formal tool for this purpose, and examine other conceptual issues pertinent to criminal cases arising from the phenomenology of AVHs.     

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.     

合并自杀的杀人行为研究(附40例分析)

目的　探索合并自杀的杀人行为的犯罪学特征、发生机理 ,为责任能力的评定提供依据 ,并提出进一步研究方向。　方法　采用回顾性研究方法 ,3名研究人员从 1997年 1月～ 2 0 0 1年 10月的鉴定案例中挑出符合研究条件的案例 ,进行统计学分析 ,并结合国内外相关文献进行讨论。　结果　符合条件者共 40例 ,男性被鉴定人较多 (2 8名 ) ,平均年龄 33.5 5岁 ,主要年龄段 30～ 40岁 ,妄想和情绪低落等症状具有明显的作用 ,精神分裂症和无精神病在疾病诊断中占有显著地位。　结论　合并自杀的杀人行为具有一定的特征 ,应引起司法精神病学的关注 ,并展开更深入的研究。     

Schizophrenia: Causes,crime, and implications for criminology and criminal justice

This paper is aimed at criminologists and criminal justicians seeking to understand their role in educating law enforcement and correctional personnel who must deal with the mentally ill. It is motivated by William Johnson's (2011) recent call for rethinking the interface between mental illness, criminal justice, and academia, and his call for advocacy. We concur with his concerns, and insist that this rethinking must necessarily include grounding in the etiology of mental illness (specifically, with schizophrenia) as it is currently understood by researchers in the area. Advocacy must go hand in hand with a thorough knowledge of the condition of the people for whom we are advocating. We first examine major etiological models of schizophrenia, emphasizing the neurodevelopmental model that incorporates genetics, neurological functioning, and immunological factors guided by the assumption that the typical criminologist/criminal justician has minimal acquaintance with such material. We then address the link between schizophrenia and criminal behavior, and conclude with a discussion of the implications for criminology and criminal justice.     

Schizophrenia,AIDS and the Decision to Prescribe HAART

SUMMARY

Individuals with schizophrenia are at risk of developing HIV and are known to experience barriers to optimal medical care. Our goal was to determine, among a cohort of HIV clinicians, whether or not the diagnosis of schizophrenia affected the clinical decision to offer highly active antiretroviral therapy (HAART) to AIDS patients.

This is a cross-sectional study of a random, national sample of HIV experts drawn from the membership of the American Academy of HIV Medicine. Participants were mailed a self-administered questionnaire with a case vignette of a new onset AIDS patient and were specifically asked whether or not they would recommend HAART treatment. Vignettes were randomly assigned to include a diagnosis of schizophrenia or not. We located 649 clinicians (93%); 347 responded (53.4%). Responders and non-responders did not differ in demographics or work characteristics. Recommendation of antiretroviral treatment did not differ between those who received a case vignette with schizophrenia versus those who did not (95.8% vs. 96.6%, p = 0.69). Compared to those who received a case vignette without schizophrenia, those who received vignettes with schizophrenia were more likely to avoid prescribing efavirenz, a medication with known neuropsychiatric side effects (17.7% vs. 45.5%, p < 0.01), more likely to agree to be helped by a specialist (34.5% vs. 12.9%, p < 0.01), and more likely to recommend directly observed therapy (20% vs.10%, p = 0.01). HIV clinicians recognize the importance of recommending HAART treatment to individuals with schizophrenia and AIDS and avoid using antiretroviral medication with known neuropsychiatric side effects.     

横穿的精神或精神分裂

法国当代哲学家德勒兹和精神分析学家费利克斯加达里合写了一本“非哲学史”的“哲学”著作《千座平台》,这也是一本后现代主义哲学的代表作品。书中把所有精神事件看成是发生在分子或基因水平上的,出现在不同的精神空间。这样的立场,不啻一场哲学革命,因为它导致了与传统形而上学不同的“横穿的精神”或精神分裂。     

精神分裂症患者的犯罪学特征与刑事责任能力的关系

目的探讨精神分裂症患者的犯罪学特征与刑事责任能力的关系。方法采用自行编制的司法精神病学鉴定案例登记量表,对133例精神分裂症涉嫌犯罪者的资料进行收集、整理、归纳。然后对其犯罪学特征与责任能力的关系做相关分析。结果精神分裂症患者涉嫌犯罪案件类型中,以暴力案件为主,依次为凶杀68例(51.1%)、伤害38例(28.6%)、纵火9例(6.8%)、抢劫4例(3.0%)、性犯罪3例(2.3%)。不同责任能力与犯罪相关因素的统计分析发现:诱发事件(χ2=91.779,P=0.000)、双方关系(χ2=76.449,P=0.000)、作案动机(χ2=11.9,P=0.001)、作案前准备(χ2=110.623,P=0.000)、自称遗忘(χ2=34.274,P=0.000)、作案后反应(χ2=110.923,P=0.000)、案件类型(χ2=38.638,P=0.000)有显著性差异。结论无责任能力的分裂症患者作案具有动机不明、无预谋、不分对象、不分场合、突发性、盲目性、残忍性等特点。无责任能力组和部分责任能力组的犯罪学因素中诱发事件、双方关系、作案动机、作案前准备、自称遗忘、作案后反应、案件类型有显著性差异,可作为责任能力评定的参考因素。     

Stigma and discrimination in mentally disordered offender patients – a comparison with a non-forensic population

High levels of stigma and discrimination are reported by individuals with mental health problems. Aim: To assess self-reported levels of stigma and discrimination in forensic psychiatric patients, with psychotic illness, compared with general adult psychiatric patients with psychosis. Hypothesis: Individuals with a history of violent offending, as well as severe mental illness, report more stigma and discrimination, than non offender patients, as a result of them being perceived as dangerous and unpredictable. Method: Experiences of stigma and discrimination were compared in 32 forensic and 32 non-forensic general psychiatric patients, with schizophrenia or schizoaffective disorder, using the Stigma and Discrimination Scale (DISC). Results: Stigma and discrimination were widely reported by all patients, particularly affecting relationships with family, intimate relationships and friendships. No significant difference emerged between the forensic and non-forensic patients, in experienced or anticipated stigma. Conclusions: We suggest that the lower level of psycho pathology, longer inpatient stays and intensive rehabilitation for forensic patients may reduce the extent to which these patients experience stigma and discrimination.     

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.