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The goal of the current study was to investigate the socio-demographic, psychiatric, and criminological characteristics of female violent offenders with mental disorders involuntarily committed to a forensic psychiatric hospital. The present study was a population-based retrospective case series including all female offenders with mental disorders found not guilty by reason of insanity by the criminal courts in the state of Rio de Janeiro, Brazil, and involuntarily committed to a forensic psychiatric facility (n = 27). Patients were assessed with Structured Clinical Interview for DSM-IV Axis I Disorders and the Positive and Negative Syndrome Scale. We found that most offenders were Afro-Brazilian, uneducated unmarried women. Schizophrenia with active psychotic symptoms was the most common clinical condition. Relatives were the frequent victims of aggressive behavior. Most patients had already been diagnosed with a mental disorder and placed under psychiatric treatment, but poor adherence and treatment dropout were common. Violent behavior in psychiatrically ill female patients is associated with a specific socio-demographic and clinical profile and is thus potentially amenable to prevention particularly if the mental health and social services are to provide the much-needed support for economically, socially, and psychologically vulnerable women.

Influenciada por experiências, ambiente, situações de vida e características herdadas, a personalidade é a maneira de um indivíduo pensar, sentir e se comportar. Os transtornos de personalidade caracterizam uma mudança nas características acima, que se desviam das expectativas culturais, causam sofrimento ou problemas de funcionamento. Indivíduos com transtornos personalidade apresentam padrões de comportamento e experiências que diferem significativamente do esperado, com implicações a longo prazo. Sem tratamento, podem ser duradouros e trazer inúmeros prejuízos ao paciente, afetando o modo de pensar em si e nos outros e as respostas emocionais.

Objective Identify factors related to bias in forensic psychiatric assessments in criminal matters. Method Based on the PRISMA guidelines, we searched the following keywords with Boolean operators: (criminal responsibility OR legal responsibility OR neurolaw OR insanity defense) AND (forensic psychiatry OR assessment OR evaluation OR bias OR decision-making OR capacity OR psychometric). The search included publications from January 1998 to December 2019 in the English language, published in PubMed, Web of Science, Taylor & Francis, and Scopus databases. Results The final sample consisted of 30 articles separated into three groups: (1) legal elements and the wording of expert reports, (2) psychometric tools applied to criminal inquiries, and (3) expert forensic technique and inter-examiner agreement. Discussion Multiple factors for biases were identified: difficulties in equivalence between legal and psychiatric terminologies, elements of countertransference between the expert and the examinee, absence of standardization of expert evaluations, low quality of expert reports, differences in the training of professionals involved in the evaluations, use of psychometric tools, number of professionals working on the same case, and the methodology adopted. Psychometric tools developed specifically for forensic psychiatric evaluations allowed the introduction of objective parameters in expert evaluations. Special attention was found in psychometric tools structured as vignettes that allowed the detailed evaluation of legal capacities, present in the legal texts. Psychometric tools in checklist format appeared to be more susceptible to interviewer biases. Conclusion The control of inherent biases in forensic psychiatry assessments on criminal matters remains a current challenge, difficult to control in forensic practice. The identification, control and avoidance of them may improve the quality the forensic psychiatric expertise in criminal matters.

O novo Código Civil Brasileiro, apesar de avançar em muitos sentidos, deixa a desejar no aspecto da manutenção da integridade dos direitos e decisões pessoais de indivíduos estabelecidos como incapazes pela lei. Embora o que se busque através do instituto da curatela seja a proteção para aqueles a quem falta a capacidade de cuidarem de si mesmos, a indicação de um curador pode trazer sérias consequências para o curatelado. Esse status legal pode privar a pessoa do direito a escolhas importantes, como aquelas relacionadas aos atos de casar-se, votar e educar crianças, aos cuidados com a saúde e consentimento com tratamentos, à escolha do lugar de residência e a outros aspectos fundamentais de uma vida comunitária. No decorrer deste artigo, comparamos as leis de curatela de países da Europa, Estados Unidos e Brasil. O Código Civil Brasileiro tem-se mostrado o mais atrasado dentre os analisados, limitando em muito os direitos pessoais de seus curatelados e ultrapassando o limiar dos direitos individuais.

Objective: To evaluate the importance of phenomenological aspects of the cognitive rumination (CR) construct in current empirical psychiatric research.Method: We searched SciELO, Scopus, ScienceDirect, MEDLINE, OneFile (GALE), SpringerLink, Cambridge Journals and Web of Science between February and March of 2014 for studies whose title and topic included the following keywords: cognitive rumination; rumination response scale; and self-reflection. The inclusion criteria were: empirical clinical study; CR as the main object of investigation; and study that included a conceptual definition of CR. The studies selected were published in English in biomedical journals in the last 10 years. Our phenomenological analysis was based on Karl Jaspers' General Psychopathology.Results: Most current empirical studies adopt phenomenological cognitive elements in conceptual definitions. However, these elements do not seem to be carefully examined and are indistinctly understood as objective empirical factors that may be measured, which may contribute to misunderstandings about CR, erroneous interpretations of results and problematic theoretical models.Conclusion: Empirical studies fail when evaluating phenomenological aspects of the cognitive elements of the CR construct. Psychopathology and phenomenology may help define the characteristics of CR elements and may contribute to their understanding and hierarchical organization as a construct. A review of the psychopathology principles established by Jasper may clarify some of these issues. Objetivo: Verificar a importância de aspectos fenomenológicos relacionados ao construto de ruminação cognitiva (RC) nas pesquisas empíricas psiquiátricas atuais.Método: Foram pesquisadas as bases de dados SciELO, Scopus, ScienceDirect, MEDLINE, OneFile (GALE), SpringerLink, Cambridge Journals e Web of Science, entre fevereiro e março de 2014, buscando artigos cujo tópico ou título contivessem os seguintes termos-chave: ruminação cognitiva; escala de resposta ruminativa; e autorreflexão. Os critérios de inclusão foram: estudos clínicos empíricos; RC como principal objeto de pesquisa; e estudos que incluíssem uma definição conceitual de RC. Foram considerados apenas artigos em inglês publicados em periódicos biomédicos nos últimos 10 anos. Nossa análise fenomenológica se fundamentou na Psicopatologia Geral de Jaspers.Resultados: Os conceitos de RC atualmente encontrados nas pesquisas empíricas utilizam majoritariamente elementos fenomenológicos em suas definições. Entretanto, esses elementos cognitivos são indistintamente entendidos como elementos objetivos (empíricos), passíveis de mensuração, e não parecem ser cuidadosamente examinados. Este fato pode contribuir para uma compreensão enganosa sobre RC, além de favorecer a interpretação errônea de resultados e a elaboração de paradoxos teóricos problemáticos.Conclusão: As pesquisas empíricas atuais sobre RC falham ao avaliar os aspectos fenomenológicos inerentes ao construto de RC. A psicopatologia e o método fenomenológico podem ajudar a definir características relacionadas aos elementos da RC, bem como contribuir para a sua compreensão e organização hierárquica enquanto construto. Um retorno aos princípios da psicopatologia, nos moldes de Jaspers, poderia trazer esclarecimentos ao tema.

Sexual violence is defined as any sexual act forced upon a person who did not give his or her consent. Our objective is to investigate the socio-demographic features, clinical correlates, criminal behaviour characteristics, and the level of penal responsibility of sexual offenders who were referred to forensic psychiatric assessment in the city of Rio de Janeiro, Brazil. This is a cross-sectional descriptive study. All written reports made in the year of 2008 by court-appointed psychiatric experts on individuals charged with having committed sexual crimes and referred to the main forensic hospital in the State of Rio de Janeiro, Brazil, for assessment were reviewed. Forty-four expert reports were identified. All alleged offenders were male. Nineteen (43.2%) offenders did not receive any psychiatric diagnostic. Nine offenders (20.4%) were diagnosed with mental retardation. In 16 cases (36.4%), some form of mental or neurological disorder was diagnosed. Thirty-one (70.4%) offenders were considered fully responsible, eight (18.2%) partially responsible, and five (11.4%) not responsible by reason of insanity. The sexual crimes allegedly perpetrated by the offenders were rape (n=14, 32%), attempted rape (n=4, 9%), indecent assault (n=26, 59%), and indecent exposure (n=5, 11.4%). In 10 cases (22.7%), the offender was under alcohol influence at the moment of the crime. The profile of Brazilian sex offenders subject to forensic psychiatric assessment were male, caucasian, single, working part time, with no mental disorder, who perpetrated indecent assault.

Objetivo: Este estudo preliminar tem por objetivo identificar e comparar características relacionadas ao comportamento violento em pacientes com esquizofrenia internados em um hospital psiquiátrico utilizando o Historical, Clinical, and Risk Management 20 (HCR-20), a Modified Overt Aggression Scale (MOAS), e dados sociodemográficos. Método: Foram selecionados participantes com e sem histórico de comportamento violento, referidos nos relatórios de internação hospitalar. Participantes violentos e com escore total do HCR-20 ≥ 21 na internação foram selecionados para o grupo violento. Participantes não violentos com escore total do HCR-20 < 21 na internação foram selecionados para o grupo não violento. A MOAS foi aplicada para caracterizar o grau de severidade do comportamento violento. Resultados: O HCR-20 e suas subescalas foram eficazes na diferenciação entre os participantes dos grupos. Doze dos 20 itens do HCR-20 foram úteis na diferenciação entre os grupos, apesar do escore total do HCR-20 ter sido mais confiável quando aplicado ao grupo não violento. A MOAS não apresentou graus de severidade elevados para os tipos de agressividade observados nos participantes. Conclusão: O HCR-20 foi útil e confiável na distinção entre pacientes esquizofrênicos violentos e não violentos em ambiente psiquiátrico clínico, já que a análise dos itens identificou as características mais relevantes em cada grupo. O uso do HCR-20 em ambientes psiquiátricos clínicos deveria ser encorajado. Objective: This preliminary study aimed to identify and compare characteristics related to violent behavior in inpatients with schizophrenia at a general psychiatric hospital using the Historical, Clinical, and Risk Management 20 (HCR-20), the Modified Overt Aggression Scale (MOAS), and sociodemographic data. Method: Violent and nonviolent participants were selected based on psychiatric admission reports. Participants with reports of aggressive behavior and HCR-20 total score ≥ 21 upon admission were assigned to the violent patient group. Participants without aggressive behavior and with HCR-20 total score < 21 upon admission were assigned to the nonviolent patient group. The MOAS was applied to characterize the degree of severity of the violent behavior. Results: HCR-20 and its subscales were effective in differentiating between the violent and nonviolent participant groups. Twelve of the 20 HCR-20 items were useful for distinguishing between the groups, although total HCR-20 scores were more reliable when applied to the nonviolent patient group. The MOAS did not show high degrees of severity for the types of aggression observed in the participants. Conclusion: HCR-20 was useful and reliable for distinguishing between violent and nonviolent patients with schizophrenia in this clinical psychiatric setting. Item analysis identified the most relevant characteristics in each group. The use of the HCR-20 in clinical psychiatric settings should be encouraged.