1,721,022 research outputs found
Is involuntary psychiatric hospitalization a measure for preventing the risk of patients’ violent behavior to self or others? A consideration of the Italian regulation
No full textObjectives
The authors focus on the issue of involuntary psychiatric hospitalization as a possible measure for preventing a patient from harming himself or others. The possibility that a mental disorder could induce people with mental illness to have violent behavior is still debated in Italy, and patients’ dangerousness is not a criterion for involuntary hospitalization. Nonetheless in several other member states of the European Union and in the USA, involuntary commitment is an acknowledged procedure to prevent this risk. Implications of the Italian jurisprudence for evaluating the psychiatrists’ alleged malpractice will be discussed, including the practical implications of psychiatrists’ duty of care.
Methods
The authors will first survey the legal framework of involuntary psychiatric hospitalization also providing examples of regulations. A critical discussion of data of recent research on involuntary psychiatric hospitalization will follow, underlining possible interactions and conflicts between concepts such as mental capacity, duty of care, professional liability, and patients’ dangerousness.
Conclusions
Although the Italian regulation for civil commitment does not include danger to self or others, nor mental capacity evaluation criteria, the clinical practice and the jurisprudence advocate their consideration
Disturbo somatoforme indifferenziato in un paziente con dispepsia funzionale associata ad infezione da Helicobacter pylori, resistente alla terapia radicante
No full text
Legislative differences may influence the characteristics of involuntary hospitalised psychiatric patients
No full textComprehensive reviews aimed at identifying factors
associated with involuntary psychiatric hospitalisation
(IPH) have recently been published,1–3 providing interesting
and challenging results.
In 2019, Walker et al. performed a meta-analysis
and observed that IPH was associated, on an individual
level, with male sex, single marital status, unemployment,
receiving welfare benefits, being diagnosed with a
psychotic disorder or bipolar disorder, previous IPH,
perceived risk to others, positive symptoms of psychosis,
reduced illness insight, reduced adherence to treatment
before hospitalisation and police involvement in
admission.3 The studies included in the meta-analysis
were performed in countries which have diverse legislation,
criteria and procedures in relation to IPH.
As the authors noted, such diversity in legal and
health-care systems may have contributed to the heterogeneity
of results.3
Taking this into consideration, it would be interesting
to explore whether different IPH-related legislative
criteria influence the individual factors associated with
IPH. For example, as reviewed by several authors,4–6
there are countries in which a key criterion for IPH is
the risk for patients to endanger themselves or other
people, which implies a certain level of aggressiveness.
In other countries, however, this is not a recognised
factor relating to IPH, and other dimensions are considered
instead, including the possibility of taking
appropriate extra hospital measures, the capacity to
provide consent and the need for urgent care. There
are also countries in which IPH can be implemented
only in relation to psychotic disorders, while in other
countries it can be implemented in relation to severe
mental disorders in general (this may or may not
include substance use disorders).4–6
It is possible that such legislative aspects can contribute
to influence the qualitative characteristics of
patients undergoing IPH, as indirectly suggested by
studies showing marked quantitative differences in
IPH rates between countries.2,7 Subsequently, while
the findings of the recently published meta-analysis3
are extremely novel, relevant and enriching, we believe
that studies on the risk factors for IPH taking into
consideration the underlying legislation systems
should be encouraged. Although we are aware of the
difficulties of such an approach, this would provide
additional information that could be readily transferred
to clinical settings
Il Disturbo Ossessivo Compulsivo (DOC): dalla clinica alle valutazioni medico legali nella valutazione di disabilità
No full textObsessive-compulsive disorder (OCD) is among the leading causes of disability in adults. Despite growing evidence provided by genetic, clinica! and neuroimaging studies, the pathophysiology of this disorder is
stili a matter of debate. Further complexity comes from the great variability in individuai response to psychiatric treatment as well as pharmacoresistance. Moreover, the variable burden of OCD is associated with the heterogeneous psychopathological symptoms and course characteristic of the disease. In the present study, we will first discuss the clinica! features of OCD, then we will focus on the most reliable assessment procedures that can be used to evaluate patients' disability within a medico-legai context
Validation of a new instrument to guide and support insanity evaluations: the defendant’s insanity assessment support scale (DIASS)
Full text linkThe insanity defense represents one of the most controversial and debated evaluations performed by forensic psychiatrists and psychologists. Despite the variation among different jurisdictions, in Western countries, the legal standards for insanity often rely on the presence of cognitive and/or volitional impairment of the defendant at the time of the crime. We developed the defendant’s insanity assessment support scale (DIASS) based on a wide view of competent decision-making, which reflects core issues relevant to legal insanity in many jurisdictions. To assess the characteristics of the DIASS we asked 40 forensic experts (16% women; years of experience = 20.6 ± 12.9) to evaluate 10 real-life derived forensic cases with the DIASS; cases included defendants’ psychiatric symptom severity, evaluated through the 24-itemBrief Psychiatric Rating Scale (BPRS). Exploratory factor analysis by principal axis factoring was conducted, which disclosed a two-factor solution explaining 57.6% of the total variance. The DIASS showed a good internal consistency (Cronbach’s alpha = 0.86), and substantial inter-rater reliability (Cohen’s kappa = 0.72). The capacities analyzed through the DIASS were mainly affected by mania/excitement and psychotic dimensions in nonresponsible and with substantially diminished responsibility defendants, while by hostility and negative symptoms in responsible defendants. The DIASS proved to be an effective psychometric tool to guide and structure insanity defense evaluations, in order to improve their consistency and reliability
The Safety of Serotonin-Noradrenaline Reuptake Inhibitors (SNRIs) in Pregnancy and Breastfeeding: A Comprehensive Review
No full textObjective: The present study provides a comprehensive review of the existing literature on the safety of serotonin-noradrenaline reuptake inhibitors (SNRIs) in pregnancy and lactation.
Methods: Studies published in English, reporting the use of SNRIs in pregnant and/or breastfeeding women, were identified by searching MEDLINE/Pubmed, PsycINFO, and EMBASE.
Results: Twenty-nine studies were included in the review. Altogether, the initial evidence coming from the reviewed studies suggests a lack of association between SNRIs and an increased risk of major congenital malformations. Conversely, exposure to SNRIs seems to be significantly associated with an increased risk of some perinatal complications. No neonatal adverse events emerged, so far, in the few studies concerning the safety of SNRIs during breastfeeding.
Conclusions: Available data suggest that venlafaxine is relatively safe during pregnancy, in particular as far as major malformations are concerned, whereas considering the small number of studies published, no definitive conclusions can be drawn on its safety during breastfeeding. Because of the few studies so far published, the safety of duloxetine during pregnancy and breastfeeding remains to be well established
Patricide and overkill: a review of the literature and case report of a murder with Capgras delusion
Full text linkDespite being an infrequent crime, parental homicide has been associated with schizophrenia spectrum disorders in adult perpetrators and a history of child abuse and family violence in adolescent perpetrators. Among severe psychiatric disorders there is initial evidence that delusional misidentification might also play a role in parricide. Parricides are often committed with undue violence and may result in overkill. The authors present the case of an adult male affected by schizoaffective disorder and Capgras syndrome who committed patricide. Forensic pathologists classify such cases as overkill by multiple fatal means comprising stabbing, blunt trauma and choking. Accurate crime scene investigations coupled with psychiatric examinations of perpetrator allow reconstruction of the murder stages. This overkill case is discussed in the context of a broad review of the literature
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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