Littérature scientifique sur le sujet « Psichiatria forense »

Il presente studio si č occupato di quei procedimenti conoscitivi in base ai quali gli psicologi e gli psichiatri effettuano le valutazioni psicodiagnostiche nell'ambito delle consulenze tecniche e delle perizie. Tali processi sono stati tradizionalmente trascurati dall'ambito clinico-forense privando i professionisti del settore di un utile confronto interdisciplinare e rendendo di dubbia validitŕ tecnicoscientifica alcune modalitŕ di indagine psicodiagnostica. Nello specifico si č voluto mettere in evidenza gli errori in cui lo specialista forense puň incorrere quando risponde agli interrogativi posti dalla committenza giuridica, sia sotto il profilo degli errori di attribuzione e delle inferenze, sia nell'ambito delle incongruenze epistemologiche.

RIASSUNTOL'internamento in Ospedale Psichiatrico Giudiziario (OPG) costituisce un allontanamento dai circuiti assistenziali psichiatrici del Servizio Sanitario Nazionale e la sua durata può influire negativamente sulle possibilità di reinserimento nel territorio di provenienza. Metodo – I fattori predittivi della durata di degenza in OPG sono stati indagati mediante una analisi di sopravvivenza condotta su una coorte di 118 pazienti degenti nei tre OPG del Centro-Nord al 30.06.97, provenienti da tre Regioni (Emilia Romagna, Toscana, Friuli Venezia Giulia), prendendo in esame le dimissioni effettuate nei 18 mesi successivi. Risultati – Da analisi di sopravvivenza condotte sui singoli fattori sono emersi, come predittori di durata di internamento, il reato commesso (omicidio: tempo mediano di permanenza 706.6 settimane, rispetto alle 307.1 e 194.7 dei reati minori e delle lesioni; log-rank =31.8, p<0.001), la durata preventivata della misura di sicurezza (RR=0.98, CI 95% 0.97-0.99, p<0.001); la diagnosi di schizofrenia (621.9 settimane rispetto alle 389.9 settimane o meno delle altre diagnosi; log-rank = 5.83, p<0.01); i disturbi del pensiero alia BPRS (RR=0.89, CI 98% 0.81-0.98, p<0.01); OPG di internamento (314.6 settimane a Montelupo Fiorentino rispetto alle 706.6 di Reggio Emilia e alle 621.9 di Castiglione delle Stiviere; log-rank = 9.64, df=2, p<0.001). In un modello di regressione di Cox a più covariate solo il tipo di reato, la durata della misura di sicurezza e la diagnosi sono risultati significativi. Conclusioni – I fattori inerenti il sistema giudiziario sono determinanti nel predire la durata della degenza. La diagnosi di schizofrenia sembra aver un ruolo indipendente nel predire una degenza più lunga

L'autore esprime alcune considerazioni psichiatrico-forensi in tema di psicoterapie alla luce della Legge 56/1989. Si sofferma in particolare sui temi inerenti la responsabilità professionale dello psicoterapeuta e sul complesso problema della preparazione necessaria allo svolgimento dell'attività psicoterapeutica da parte di medici e psicologi.

La testimonianza del minore presenta aspetti di specifica complessità e la letteratura criminologica, psichiatrico-forense e giuridica analizza approfonditamente i compiti dell'esperto sotto il profilo metodologico, clinico ed, altresì, deontologico. Si segnala per la sua complessità la particolare situazione che si crea allorché il minore, non di rado all'interno di un reato di gruppo, riveste il duplice ruolo di testimone e di autore di reato. Anche gli importanti cambiamenti che interessano la cultura sociale e le sollecitazioni che derivano dalla comunicazione multimediale possono facilitare ulteriormente l'intrecciarsi dei ruoli di testimone ed autore di reato. Si pongono in tali contesti problemi specifici ai quali la riflessione criminologica può fornire un contributo, segnatamente nella prospettiva della prevenzione primaria e secondaria.

"Introduction. Child custody judicial course usually are intense conflictual raising a lot of pressure both on adult parents as on children. Always require a forensic psychiatry set-up at the court request and a professional team, legal doctors, psychiatrists, psychologists of adult and children from the legal medicine institution and from the hospital. Children are carefully looked upon separately by psychologists in a special setu-up diregarding intruding and manipulation. Objective of this presentation is to identify ethical aspects of the relationship physician-patient (the adult parent and separate the child) and psychologist-patient (i.e. similar) in custody litigation. Material and methods. We have casuistry with a high diversity of parental alienation in child custody cases. Discussions: Does physicians (psychiatrist or legal doctor) and psychologists uses different ethical models and concepts to approache the adult parent or the child? Forensic psichiatry examinations are completed with psychiatry examination and psychology examination as much as documents examinations which are presented in the dossier. Social inquiry is very important. Conclusions: similar to physician-patient relationship in pediatry, psychologist-minor patient relationship is based on the same moral values and ethical principles: beneficence, nonmaleficence, justice, loialty, trust, mostly in a paternalistic model to sustain always the best interest of the child/children. Lack of autonomy of the minor child creates correlativity obligations to protect his rights and to sustain the best interests of the child as a primary consideration. Beneficence in forensic psychiatry may take into consideration maintaining also beneficial emotional relationships with both parents after the separation. "

Klinefelter Syndrome (KS) (XXY) is the most common sex-chromosome aberration among men. The cognitive phenotype includes language learning problems, mental retardation, and psychiatric disorders. Patients can show criminal personality and psychosocial problems. The most common offences reported are sexual abuse, arson, burglary, homicide, drug-related crimes. KS very often goes under-diagnosed. The aim of our study is to verify the hypothesis of correlation between chromosomal abnormalities and criminal behaviors through the analysis of a forensic case of uxoricide/suicide. We report the case of an old man, found dead in his cottage with a gun in the right hand. Judicial inspection demonstrated suicidal single gunshot injuries. Data analysis highlighted a personal story of uxoricide. Autopsy investigation showed the typical KS phenotype. The post-mortem clinical diagnosis was confirmed through the genetic analysis of the karyotype. The retrospective analysis of literature with this case showed a possible correlation between KS and psychiatric traits, with criminal personality and sexual disorders. RiassuntoLa Sindrome di Klinefelter (KS) (XXY) è l'aberrazione cromosomica più comune tra gli uomini. Il fenotipo cognitivo include problemi di apprendimento linguistico, ritardo mentale e disturbi psichiatrici. I pazienti possono mostrare personalità criminale e problemi psicosociali. I reati più comuni riportati sono abusi sessuali, incendio doloso, furto con scasso, omicidio, reati connessi alla droga. KS molto spesso va sotto-diagnosticato. Lo scopo del nostro studio è verificare l'ipotesi di correlazione tra anomalie cromosomiche e comportamenti criminali attraverso l'analisi di un caso forense di uxoricide / suicidio. Riportiamo il caso di un vecchio, trovato morto nella sua casetta con una pistola nella mano destra. Ispezioni giudiziarie hanno dimostrato lesioni suicide con singolo colpo d'arma da fuoco. L'analisi dei dati ha evidenziato una storia personale di uxoricide. L'indagine dell'autopsia ha mostrato il tipico fenotipo KS. La diagnosi clinica post-mortem è stata confermata attraverso l'analisi genetica del cariotipo. L'analisi retrospettiva della letteratura con questo caso ha mostrato una possibile correlazione tra KS e tratti psichiatrici, con personalità criminale e disturbi sessuali. ResumenEl síndrome de Klinefelter (KS) (XXY) es la aberración de cromosomas sexuales más común entre los hombres. El fenotipo cognitivo incluye problemas de aprendizaje del lenguaje, retraso mental y trastornos psiquiátricos. Los pacientes pueden mostrar personalidad criminal y problemas psicosociales. Los delitos más comunes reportados son abuso sexual, incendio premeditado, robo, homicidio, delitos relacionados con drogas. KS muy a menudo va bajo diagnosticado. El objetivo de nuestro estudio es verificar la hipótesis de correlación entre las anomalías cromosómicas y las conductas delictivas mediante el análisis de un caso forense de uxoricida / suicidio. Informamos el caso de un anciano, encontrado muerto en su casa con un arma en la mano derecha. La inspección judicial demostró lesiones suicidas con un solo disparo. El análisis de datos resaltó una historia personal de uxoricidio. La investigación autopsia mostró el fenotipo típico de KS. El diagnóstico clínico post mortem se confirmó mediante el análisis genético del cariotipo. El análisis retrospectivo de la literatura con este caso mostró una posible correlación entre el SK y los rasgos psiquiátricos, con personalidad criminal y trastornos sexuales.

About 40 years after the reforms leading to the closure of psychiatric hospitals (Ospedale Psichiatrico [OP]) in Italy in favor of a widespread model with a strong rehabilitation emphasis, Italy has chosen to close High Security Hospitals as well (Ospedale Psichiatrico Giudiziario [OPG]). The new forensic treatment model is expected to be more respectful of the person, including the perpetrators of violent crimes, and aims to be less stigmatizing and more rehabilitative. Despite the favorable premises of the reform (Law n. 81/2014), Italian psychiatrists are now obliged to answer calls to give evidence on strictly legal issues such as the social dangerousness of the mentally ill offender drawing on evidence or paradigms that many believe do not belong to medical knowledge. Psychiatrists must now learn to communicate about the relationship between psychiatry and society as required by law. This public expression engages with the cultural climate of society. Otherwise, the risk is of increasing the level of complexity leading to real misunderstandings that paradoxically may feed the stigma. The Italian reform provides an opportunity for reflection on some issues concerning psychiatric action, on how the public perceives the mentally ill and their psychiatrists, on the relationship between psychiatry and the world of law, on clinical methodologies for structured professional judgment, on public communication regarding severe mental illness, and the risk that psychiatrists may inadvertently be blamed for conveying an unwelcome message about mental illness and social dangerousness—we have called this social sensitivity against psychiatrists “hermanoia,” blaming the messenger. The authors do not provide certain solutions but propose good practices.

Dabar mūsų šalyje psichologams (išskyrus klinikinio psichologo specializaciją) ribojamos galimybės atlikti teismo psichologines ekspertizes, neatsižvelgiant į psichologo turimą kvalifikaciją, įgytą patirtį ar mokslo laipsnį. Tokia situacija nėra pagrįsta nei teisiniu, nei profesiniu, nei praktiniu požiūriu. Ji susidarė todėl, kad istoriškai psichologinė teismo ekspertizė gimė kaip sudedamoji psichiatrinės ekspertizės dalis ir ilgą laiką buvo vertinama kaip pagalbinė, „aptarnaujanti“ psichiatrinę. Ieškant problemos sprendimo būdų, reikėtų parengti naują teismo psichologinės ekspertizės norminį aktą, kuris atspindėtų modernios teismo psichologinės ekspertizės statusą. Straipsnio pabaigoje pateikiami konkretūs pasiūlymai, kurių įgyvendinimas skatintų rungtynišką teismo psichologinę ekspertizę, leistų įtraukti į ekspertizių atlikimą Lietuvos psichologų sąjungą, taip pat mokslininkus ir mokslo įstaigas, atliekančias psichologinės ekspertizės tyrimus. Pagrindiniai žodžiai: teismo psichologas ekspertas, Teismo ekspertizės įstatymas, teismo psichologinės ekspertizės norminis aktas, rungtyniška teismo psichologinė ekspertizė. PSYCHOLOGICAL EVALUATION IN COURT IN LITHUANIA: PRESENT SITUATION, PROBLEMS AND POSSIBLE SOLUTIONSGintautas Valickas, Viktoras Justickis, Ilona Čėsnienė SummaryAccording to Law of Forensic Expertise of Lithuania, only a person who has sufficient legal and psychological knowledge and passed appropriate exams can obtain the status of an expert in forensic psychology. Unfortunately, the possibilities of professional psychologists (excluding clinical psychologists) to exercise forensic psychological expertise are limited without a good reason. Obscure rules of evaluation of qualifications and practical experience regulate the process of becoming a licensed expert in forensic psychology. These rules are not based on legal, professional or practical analysis. This is a result of the historical situation when for a long time psychological expertise has been considered to be part of psychiatry and was only additional „servicing“ activity of expertise of psychiatry. Problems of education and training of experts in forensic psychology (EEP) are described in this article. At present, demand for EFP services is growing. Judges, interrogation officers, investigators need more and more special knowledge in the field of psychology, especially when analyzing the ability of juvenile witnesses to provide credible information, the ability of juveniles to understand the situation and to provide their opinion in the cases of custody or adoption. At present, the number of EEPs remains the same. A lot of psychologists who have good knowledge and experience can only consult but cannot act as experts. There are no EFP to participate actively in research activities. Moreover, the Office of Forensic Psychiatry does not provide any information and refuses to coach psychology students on practical aspects of expert work. They withhold information on expertise methods as well. The Council of Experts does not include any psychologists, and psychiatry experts represent the opinion of psychologists too. One of the possible solutions to this situation is preparation of a new legal act on forensic psychology, which would regulate the status of psychological expertise according to the new modern approach. Detailed proposals are provided at the end of the article. Implementation of the proposals would encourage the competitive process of psychological expertise and facilitate involvement of the Lithuanian Psychological Association, scientific institutions and scientists working in this area. Keywords: expert in forensic psychology, the Law of Forensic Expertise, legal act on forensic psychological expertise, adversarial forensic psychological expertise.

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The legislative innovation introduced by Law 81/2014 ratified that the implementation of the custodial Security Measures and the consequent admission in REMS (Residences for the Execution of Security Measures) of psychiatric patients offenders constituted a condition of extrema ratio to be activated only where "every other measure has proved to be not appropriate to ensure adequate care and to cope with the patient's social dangerousness". Given that the law has intervened on a legal structure unchanged and rigidly focused on the concept, now obsolete, of social dangerousness, it was expected that the new legislative orientation determined a clear reduction of the custodial Security Measures in view of a more objective and clear assessment of category of danger best described as a risk of recidivism. In fact it was expected that the forensic psychiatry could finally participate in the "scientific" construction of the social dangerousness’ concept, based on the survey and evaluation of the presence and extent of potential risk factors and protection in the case, with the prospect of contribute to a sort of "risk assessment" of violent behavior of the psychic suffering. OBJECTIVES: The aim of the study is to assess how the intervention of the law 81 has changed number and social dangerousness profile of patients undergone a custodial security measure. METHODS: We recruited all patients interned in the Judicial Psychiatric Hospital of Castiglione delle Stiviere in the previous year of the REMS’ opening and compared, about social dangerousness and clinical and legal variables, to all the subjects interned within the following year of the Judicial Psychiatric Hospital closure. The assessment of the risk of recidivism (risk assessment) was carried out by the administering of actuarial scales (VRAG; HCR-20, PCL-R) capable of identifying a risk class. RESULTS: Analysis of the data would seem to indicate that the legislative innovation nothing has changed in terms of the number of designations and hazard profiles, glimpsing a wide level of criticality regarding the ways and possibilities of application of the law itself.

L'elaborato si basa sulla biografia storica dello psichiatra pratese Carlo Livi (1823-1877), una delle figure chiave della psichiatra italiana dell’Ottocento. La tesi si sofferma sia sulla sua opera di carattere medico-psichiatrico e medico-forense, sia sulle tappe fondamentali della sua vita di uomo, di medico e di intellettuale vissuto durante gli anni centrali del Risorgimento italiano.