RESUMEN
Competence to stand trial is a legal construct used to identify those criminal defendants who have the requisite mental capacity to understand the nature and objective of the proceedings against them and to participate rationally in preparing their defense. This Practice Guideline has described how psychiatrists should evaluate individuals concerning their competence to stand trial. The Guideline describes acceptable forensic psychiatric practice for such evaluations. Where possible, it specifies standards of practice and principles of ethics and also emphasizes the importance of analyzing an individual defendant's case in the context of statutes and case law applicable in the jurisdiction where the evaluation takes place. The recommendations in the Guideline both reflect and are limited by evolving case law, statutory requirements, legal publications, and the current state of psychiatric knowledge. The authors have taken note of nationally applicable case law, federal constitutional standards, statutory language, and federal and state interpretations of the rights or statutes, recognizing that jurisdictions may differ in their specific interpretation or application of statutes or general constitutional standards. The review of cases concerning specific psychiatric diagnoses illustrates general U.S. trends, and psychiatrists must remain cognizant of their jurisdictions' interpretations of statutes or constitutional requirements. By surveying a variety of practices and approaches to data gathering and case analysis, the authors believe that this Guideline will stimulate additional collegial discussion about what is necessary and sufficient for adequate evaluations of adjudicative competence. The notion that psychiatrists should apply expertise to competence assessments stems from the principal that, before allowing a defendant to face criminal prosecution and possible punishment, courts need reasonable assurance--based, if necessary, on a careful, individualized evaluation--that the defendant has adequate mental capacity to make a defense. At a minimum, a psychiatrist's opinion about adjudicative competence should reflect an understanding of the jurisdictional standard and of how the defendant's mental condition affects competence as defined with the jurisdiction. The psychiatrist's report should clearly describe the opinion and the reasoning that leads to it. Psychiatrists who provide mental health expertise concerning adjudicative competence give trial courts information needed to assure that defendants can appropriately protect themselves and that criminal proceedings will be accurate, dignified,and just.
Asunto(s)
Testimonio de Experto , Psiquiatría Forense , Competencia Mental/legislación & jurisprudencia , Trastornos Mentales/diagnóstico , Adolescente , Adulto , Niño , Competencia Cultural , Documentación , Testimonio de Experto/ética , Testimonio de Experto/legislación & jurisprudencia , Psiquiatría Forense/ética , Psiquiatría Forense/legislación & jurisprudencia , Humanos , Entrevista Psicológica , Menores/legislación & jurisprudencia , Pruebas Psicológicas , Estados UnidosRESUMEN
Forensic hospital records of 39 severely mentally ill mothers adjudicated Not Guilty by Reason of Insanity for filicide (child murder by parents) were analyzed to describe characteristics preceding this tragedy and to suggest prevention strategies. Almost three-quarters of the mothers (72%) had previous mental health treatment. Over two thirds (69%) of the mothers were experiencing auditory hallucinations, most frequently command hallucinations, and half (49%) were depressed at the time of the offense. Over one third (38%) of the filicides occurred during pregnancy or the postpartum period, and many had a history of postpartum psychosis. Almost three-quarters (72%) of the mothers had experienced considerable developmental stressors, such as death of their own mother or incest. Maternal motives for filicide were predominantly "altruistic" (meaning murder out of love) or "acutely psychotic" (occurring in the throes of psychosis, without rational motive). Psychiatrists should perform careful risk assessments for filicide in mothers with mental illnesses.
Asunto(s)
Psiquiatría Forense , Homicidio , Defensa por Insania , Enfermos Mentales/psicología , Madres/psicología , Adolescente , Adulto , Niño , Maltrato a los Niños/estadística & datos numéricos , Custodia del Niño , Preescolar , Depresión/psicología , Depresión Posparto/psicología , Femenino , Alucinaciones/psicología , Humanos , Lactante , Recién Nacido , Acontecimientos que Cambian la Vida , Métodos , Michigan/epidemiología , Persona de Mediana Edad , Motivación , Ohio/epidemiología , Trastornos de la Personalidad/epidemiología , Embarazo , Estudios Retrospectivos , Estrés Psicológico/psicología , Trastornos Relacionados con Sustancias/epidemiologíaRESUMEN
The purpose of this phenomenological study was to identify commonly occurring factors in filicide-suicide offenders, to describe this phenomenon better, and ultimately to enhance prevention of child murder. Thirty families' files from a county coroner's office were reviewed for commonly occurring factors in cases of filicide-suicide. Parental motives for filicide-suicide included altruistic and acutely psychotic motives. Twice as many fathers as mothers committed filicide-suicide during the study period, and older children were more often victims than infants. Records indicated that parents frequently showed evidence of depression or psychosis and had prior mental health care. The data support the hypothesis that traditional risk factors for violence appear different from commonly occurring factors in filicide-suicide. This descriptive study represents a step toward understanding filicide-suicide risk.
Asunto(s)
Homicidio/estadística & datos numéricos , Relaciones Padres-Hijo , Suicidio/estadística & datos numéricos , Adulto , Niño , Violencia Doméstica/legislación & jurisprudencia , Violencia Doméstica/estadística & datos numéricos , Familia/psicología , Composición Familiar , Padre/estadística & datos numéricos , Femenino , Humanos , Masculino , Trastornos Mentales/epidemiología , Trastornos Mentales/psicología , Persona de Mediana Edad , Madres/estadística & datos numéricos , Estudios RetrospectivosRESUMEN
OBJECTIVE: Lack of insight affects the management of schizophrenia. The interrelationship between lack of insight and illness attributes in patients with schizophrenia who commit violent acts is important and underresearched. METHOD: One hundred fifteen violent patients with schizophrenia in a jail or court psychiatric clinic were evaluated on measures of symptoms, illness severity, insight into illness, and the legal consequences of their illness ("forensic insight"). A sample of nonviolent patients served as a comparison group. RESULTS: Compared with the nonviolent cohort, violent patients were more symptomatic, had poorer functioning, and had a more prominent lack of insight. Deficits of insight into illness coexisted with a lack of forensic insight, which was also associated with psychosis. CONCLUSIONS: Patients with schizophrenia who commit violent acts have insight deficits, including lack of awareness of the legal implications of their behavior. Targeted interventions to improve insight and treatment compliance in this population are warranted.
Asunto(s)
Concienciación , Esquizofrenia/diagnóstico , Psicología del Esquizofrénico , Violencia/psicología , Adulto , Síntomas Conductuales/diagnóstico , Síntomas Conductuales/psicología , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/psicología , Estudios de Cohortes , Crimen/legislación & jurisprudencia , Femenino , Psiquiatría Forense/legislación & jurisprudencia , Estado de Salud , Humanos , Masculino , Ohio/epidemiología , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Calidad de Vida , Índice de Severidad de la Enfermedad , Prueba de Secuencia AlfanuméricaRESUMEN
Aggression among patients with serious mental illness occurs relatively infrequently, but it is a significant concern for patients, relatives, mental health professionals, and the public. Recognition of this risk and providing access and continuity of appropriate psychiatric care should be major clinical and administrative objectives in the management of violence in psychotic patients. To date, pharmacologic approaches have been unclear and inconsistent. At present, typical antipsychotics continue to have a primary role in acute management and in long-term management, in which noncompliance necessitates the use of long-acting depot neuroleptic preparations. Atypical antipsychotics in acute and long-acting intramuscular forms doubtless will influence and expand the choice for acute management of hostile psychotic patients and the long-term management of poorly compliant patients who are at risk to become violent on relapse. Persistent aggression should be managed by atypical antipsychotics with a preferential indication for clozapine, for which the most data on efficacy are available. The role of adjunctive medications is presently unclear. A major focus of care should be to refine legal processes and to conduct intervention studies aimed at enhancing treatment compliance. Violence risk reduction is not only crucial from a societal perspective, but also it is a humanitarian necessity to alleviate the burden and stigma for patients with serious mental illness.
Asunto(s)
Antipsicóticos/uso terapéutico , Psicoterapia/métodos , Trastornos Psicóticos/psicología , Trastornos Psicóticos/terapia , Violencia/psicología , Antipsicóticos/clasificación , Femenino , Humanos , Masculino , Trastornos Psicóticos/tratamiento farmacológico , Factores de RiesgoRESUMEN
The authors present the case of a man who was hospitalized after claiming that he was about to become a serial killer. The patient presented with extensive written homicidal fantasies and homicidal intentions without evidence of actual homicidal acts. In addition to routine assessments, hospital staff members used case conferences, psychological testing, outside forensic consultation, and a forensic review process to make decisions regarding diagnosis, treatment planning, and discharge. The patient was discharged after 8 months of inpatient treatment and was apparently free of homicidal impulses or symptoms of severe mental illness. A 2-year court commitment allowed for the enactment and potential enforcement of a discharge plan that was endorsed by the patient, the hospital, and community care providers. The authors review diagnostic and risk management issues. Comparisons with known features of typical serial killers are made.