Forensic psychiatric evaluations of defendants: Italy and the Netherlands compared
ارزیابی روانپزشکی پزشکی قانونی از متهمان: ایتالیا و هلند در مقایسه-2019
Background: Forensic psychiatric practices and provisions vary considerably across jurisdictions. The diversity provides the possibility to compare forensic psychiatric practices, as we will do in this paper regarding Italy and the Netherlands. Aim: We aim to perform a theoretical analysis of legislations dealing with the forensic psychiatric evaluation of defendants, including legal insanity and the management of mentally ill offenders deemed insane. This research is carried out not only to identify similarities and differences regarding the assessment of mentally ill offenders in Italy and the Netherlands, but, in addition, to identify strengths and weaknesses of the legislation and procedures used for the evaluation of the mentally ill offenders in the two countries. Results: Italy and the Netherlands share some basic characteristics of their criminal law systems. Yet, forensic psychiatric practices differ significantly, even if we consider only evaluations of defendants. A strong point of Italy concerns its test for legal insanity which defines the legal norm and enables a straightforward communication between the experts and the judges on this crucial matter. A strong point of the Netherlands concerns more standardized practices including guidelines and the use of risk assessment tools, which enable better comparisons and scientific research in this area. Conclusions: We argue that there appears to be room for improvement on both sides with regards to the evaluation of mentally ill offenders. More generally, a transnational approach to these issues, as applied in this paper, could help to advance forensic psychiatric services in different legal systems.
Keywords: Forensic psychiatry | Legal insanity | Italy | Netherlands | Risk assessment
Psychiatric patients requesting euthanasia: Guidelines for sound clinical and ethical decision making
بیماران روانی درخواست کشتن از سر ترحم: دستورالعمل هایی برای تصمیم گیری بالینی و اخلاقی سالم-2019
Background: Since Belgium legalised euthanasia, the number of performed euthanasia cases for psychological suffering in psychiatric patients has significantly increased, as well as the number of media reports on controversial cases. This has prompted several healthcare organisations and committees to develop policies on the management of these requests. Method: Five recent initiatives that offer guidance on euthanasia requests by psychiatric patients in Flanders were analysed: the protocol of Ghent University Hospital and advisory texts of the Flemish Federation of Psychiatry, the Brothers of Charity, the Belgian Advisory Committee on Bioethics, and Zorgnet-Icuro. These were examined via critical point-by-point reflection, focusing on all legal due care criteria in order to identify: 1) proposed measures to operationalise the evaluation of the legal criteria; 2) suggestions of additional safeguards going beyond these criteria; and 3) remaining fields of tension. Results: The initiatives are well in keeping with the legal requirements but are often more stringent. Additional safeguards that are formulated include the need for at least two positive advices from at least two psychiatrists; an a priori evaluation system; and a two-track approach, focusing simultaneously on the assessment of the patients euthanasia request and on that persons continuing treatment. Although the initiatives are similar in intent, some differences in approach were found, reflecting different ethical stances towards euthanasia and an emphasis on practical clinical assessment versus broad ethical reflection. Conclusions: All initiatives offer useful guidance for the management of euthanasia requests by psychiatric patients. By providing information on, and proper operationalisations of, the legal due care criteria, these initiatives are important instruments to prevent potential abuses. Apart from the additional safeguards suggested, the importance of a decision-making policy that includes many actors (e.g. the patients relatives and other care providers) and of good aftercare for the bereaved are rightly stressed. Shortcomings of the initiatives relate to the aftercare of patients whose euthanasia request is rejected, and to uncertainty regarding the way in which attending physicians should manage negative or conflicting advices, or patients suicide threats in case of refusal. Given the scarcity of data on how thoroughly and uniformly requests are handled in practice, it is unclear to what extent the recommendations made in these guidelines are currently being implemented.
Keywords: Medical assistance in dying | Psychiatry | Mental health | Belgium | Euthanasia | Guidelines
Legal cynicism: Independent construct or downstream manifestation of antisocial constructs? New evidence
بدبینی حقوقی: ساختاری مستقل یا مظاهر پایین دست سازهای ضد اجتماعی؟ شواهد جدید-2019
Researchers have found that legal cynicism is a significant predictor of crime. Although legal cynicism developed as a form of anomie, it is also plausible that legal cynicism is itself a deviant rationalization to justify ones criminal behavior. As such, legal cynicism might be a derivative manifestation of other individual-level constructs that bear on criminal propensity. We test this possibility by controlling for temperament traits related to antisocial behavior and psychopathic personality features in a sample of residentially incarcerated youth (N=253). Results from negative binomial models revealed that legal cynicism was significantly associated with self-reported delinquency (including violence), but not total arrests. The significant associations with general delinquency and violence held even when controlling for sociodemographic characteristics. However, the associations were rendered either non-significant or greatly attenuated when we included temperament and psychopathy measures in the models. Overall, findings are convergent with the notion that legal cynicism is a consequence or product of antisocial traits and criminal propensity
Keywords: Legal cynicism | Juvenile offenders | Delinquency | Psychopathy | Temperament
Error-related brain activity in relation to psychopathic traits in multiproblem young adults: An ERP study
فعالیت مغزی مرتبط با خطا در رابطه با صفات روانی در بزرگسالان جوان چندبعدی: یک مطالعه ERP-2019
One of the most prominent issues in psychopathy is the inability to adequately monitor one’s performance and learn from one’s mistakes. We investigated the relationship between psychopathic traits, as measured with the Youth Psychopathy Inventory – Short Version, and both early and late error-related brain activity in an at-risk sample of male young adults. These multi-problem young adults (age 18–27) are severely dysfunctional in society and suffer from multiple problems including financial problems, delinquency, psychological problems, and drug use. Our final sample consisted of 115 multi-problem young adults and 26 controls. Participants performed an Eriksen-Flanker task during EEG measurements. We used the difference wave of the error-related negativity (ΔERN) as a measure of early error processing and the error positivity (Pe) as a measure of late error processing. Multi-problem young adults showed reduced ERN amplitudes compared to controls, but did not differ in Pe amplitude. We found no statistically significant relation between psychopathic traits and ERN and Pe amplitudes within the multi-problem group. Thus, we found evidence for dysfunctional error-processing in multi-problem young adults compared to controls. However, within the multi-problem sample we did not find evidence for a relationship between psychopathic traits and dysfunctional error-processing. One explanation may be that this is due to the specific developmental stage of our young adult participants in which a transition between error-processing deficits, as present in adolescents high in psychopathic traits, and error-processing overcompensation, as present in adults high in psychopathic traits, may occur.
Keywords: Psychopathy | Electroencephalography | Event-related potential | Young adulthood |Error-processing | Error-related negativity
Translational machine learning for psychiatric neuroimaging
یادگیری ماشین ترجمه ای برای تصویربرداری عصبی روانی-2019
Despite its initial promise, neuroimaging has not been widely translated into clinical psychiatry to assist in the prediction of diagnoses, prognoses, and optimal therapeutic strategies. Machine learning approaches may enhance the translational potential of neuroimaging because they specifically focus on overcoming biases by optimizing the generalizability of pipelines that measure complex brain patterns to predict targets at a singlesubject level. This article introduces some fundamentals of a translational machine learning approach before selectively reviewing literature to-date. Promising initial results are then balanced by the description of limitations that should be considered in order to interpret existing research and maximize the possibility of future translation. Future directions are then presented in order to inspire further research and progress the field towards clinical translation.
Keywords: Machine learning | Neuroimaging | Translational psychiatry | MRI Deep learning
Using machine learning to explain the heterogeneity of schizophrenia: Realizing the promise and avoiding the hype
استفاده از یادگیری ماشین برای توضیح ناهمگونی اسکیزوفرنی: تحقق وعده و پرهیز از اعتیاد به مواد مخدر-2019
Despite extensive research and prodigious advances in neuroscience, our comprehension of the nature of schizophrenia remains rudimentary.Our failure to make progress is attributed to the extremeheterogeneity of this condition, enormous complexity of the human brain, limitations of extant research paradigms, and inadequacy of traditional statistical methods to integrate or interpret increasingly large amounts of multidimensional information relevant to unravelling brain function. Fortunately, the rapidly developing science of machine learning appears to provide tools capable of addressing each of these impediments. Enthusiasm about the potential of machine learning methods to break the current impasse is reflected in the steep increase in the number of scientific publication about the application of machine learning to the study of schizophrenia. Machine learning approaches are, however, poorly understood by schizophrenia researchers and clinicians alike. In this paper, we provide a simple description of the nature and techniques of machine learning and their application to the study of schizophrenia.We then summarize its potential and constraints with illustrations fromsix studies of machine learning in schizophrenia and address some common misconceptions about machine learning.Wesuggest some guidelines for researchers, readers, science editors and reviewers of the burgeoning machine learning literature in schizophrenia. In order to realize its enormous promise,we suggest the need for the disciplined application of machine learning methods to the study of schizophrenia with a clear recognition of its capability and challenges accompanied by a concurrent effort to improve machine learning literacy among neuroscientists and mental health professionals.
Keywords: Machine learning | Schizophrenia | Methods | Research | Neuroscience | Computational psychiatry | -omics | Big data | Hype | Promise
Psychiatric Community Crisis Services for Youth
خدمات روانپزشکی جامعه بحران برای جوانان-2018
KEYWORDS : Community ، Child ، Family ، Psychiatry ، Crisis ، Emergency ، Services ، Interventions
Good psychiatric management: a review
مدیریت خوب روانپزشکی: بازبینی-2018
Borderline personality disorder (BPD) has moved from being an untreatable disorder to a disorder with multiple evidence based psychotherapies. When a second generation of research showed that less intensive, easier-to-learn therapies could be nearly as effective, they offered an approach that would be responsive to the persisting unmet needs of these patients. This paper describes good psychiatric management (GPM), a once-weekly, generalist model that medicalizes the disorder, emphasizes psychoeducation, and focuses on social adaptation. It is proposed that this approach be the primary intervention for BPD; more intensive evidence-based psychotherapies thereby reserved for those who fail to respond. It is also suggested that whether GPM’s focus on social adaptation yields significant effects that improve outcome in this domain deserves testing.
Addresses : 1 McLean Hospital, 115 Mill Street, M/S 312, Belmont, MA 02478, USA 2 Pomona College, USA 3 Harvard Medical School, USA
Psychology and psychiatry in Singapore courts: A baseline survey of the mental health landscape in the legal arena
روانشناسی و روانپزشکی در دادگاه سنگاپور: یک بررسی پایه از چشم انداز سلامت روان را در عرصه حقوقی-2017
Despite the increasing prevalence and involvement of mental health professionals in local courts, there has been no systematic study of the role played by these expert witnesses in Singapore courtrooms. An empirical study of all existing recorded cases on Lawnet (Singapores legal database of all court trial cases) from 1975–2014 involving psy chologists and psychiatrists was conducted. Results revealed that, not only were these mental health experts in creasingly dotting the landscape of the legal arena, the variety of their contributions has also been gradually growing. Furthermore, there were marked differences across criminal, civil and custody cases with regards to the issues of how these experts were consulted and how their inputs utilized and appreciated by judges. Differences be tween psychology and psychiatry were also apparent. A future with more assistance rendered by these professions to courts, as well as greater synergy between law and mental health, was predicted for Singapore courts.
Keywords: Mental health | Expert witness | Singapore | Courts
Improving the rigor of psychophysiology research
بهبود سختی تحقیقات روانپزشکی-2017
Psychology as a field is in the midst of what is sometimes called a “crisis” because false findings are prevalent. Al though the focus of the methodological and substantive criticisms of psychology has focused on social psychol ogy, psychophysiology research is not without its problems. The author discusses (a) researcher flexibility and its impact on the stability of conclusions and (b) the role power plays in the probability that a finding is true and the precision of estimates. The author uses examples and data from psychophysiological research to illustrate the problems. The author concludes with a discussion of ways to shift the practice of science to improve the re liability of findings. Suggestions for improvement include: increased power through collaboration, improved sta tistical and methodological training, pre-registration of studies, improved reporting standards, and shifting incentives surrounding hiring and promotion.
Keywords: Replication | Rigor | Statistical power