Daniel Martins de Barros

Association between personality disorder and violent behavior pattern

Personality disorders are associated with criminality and antisocial and borderline personalities as strong predictors of violence. Nevertheless antisocial patients show more instrumental violence, while borderline patients more emotional violence. We surveilled medical records of a personality disorder facility, searching data of aggression and crimes against property among 11 patients with antisocial personality disorder and 19 borderline personality disorder. We found that there are differences regarding engagement in violence and lawbreaking according to the personality disorder: antisocial patients statistically engage more in crimes against property than the borderline patients, and more in this kind of crime than in aggression, whilst borderline patients show a tendency to engage more in episodes of aggression and physical violence than antisocial patients, and less in crimes against property. We conclude that the distinct personality leads to a distinct pattern of crimes and violence: antisocial patients are cold and get more involved in crimes requiring more detailed planning, whilst borderline patients are impulsive and engage in explosive episodes of physical violence. Further studies on the association among personality disorder, behavior pattern and violence type may be useful for both treatment and criminal profiling.

Perfil psicológico e comportamental de agressores sexuais de crianças

BACKGROUND: Sexual violence against children is a universal problem, occurring since ever, everywhere and regardless the socio-economic status. Whist most studies have been dedicated to the victim of such crime, there is little information regarding their perpetrators, which is largely limited to the description of demographic data. OBJECTIVE: Review the literature regarding children sexual aggressors according to psychological and behavioral profile. METHODS: Literature review and discussion. RESULTS: Presentation of the major classifications of offenders, pointing out the most widely used ones and the implications to forensic psychiatry and psychology. CONCLUSION: The psychological and behavioral profile use is very important for medico-legal practice, but still needs better scientific validation.

Dados demográficos, psicológicos e comportamentais de crianças e adolescentes vítimas de abuso sexual

CONTEXTO: A relacao entre transtorno mental e historico de abuso sexual e frequentemente observada na pratica clinica e relatada na literatura. OBJETIVO: Descrever os dados demograficos e os aspectos emocionais e comportamentais em criancas e adolescentes vitimas de abuso sexual. METODO: 205 criancas e adolescentes com idade entre 6 e 14 anos, sendo 130 meninas (9,6 ± 3,4 anos) e 75 meninos (7,2 ± 2,9 anos) vitimas de abuso sexual passaram por avaliacao psicologica e psiquiatrica individual no periodo de 2005 a 2009. As variaveis estudadas foram: genero, faixa etaria, grau de relacao da vitima com o perpetrador, aspectos psicologicos, dados psiquiatricos, aspectos comportamentais e afetivo-emocionais (culpa, vergonha, medo, inseguranca, percepcao da figura masculina e feminina e de si em relacao ao ambiente). RESULTADOS: As meninas sao as maiores vitimas (63,4%). A faixa etaria de maior risco para as meninas e entre 7 e 10 anos de idade (48,5%), enquanto para os meninos e de 3 a 6 anos (54,6%). Os pais sao os maiores perpetradores do abuso sexual (38%), seguidos do padrasto (29%). Meninos e meninas expressaram elevada frequencia para depressao e transtorno de estresse pos-traumatico (TEPT). As meninas expressam comportamento mais erotizado, enquanto os meninos ficam mais isolados. CONCLUSAO: Este estudo permitiu identificar uma parcela relevante de aspectos psicologicos, psiquiatricos e comportamentais, os quais podem afetar de forma impactante o desenvolvimento emocional de criancas e adolescentes.

Prevalence of mental disorders among sexual offenders and non-sexual offenders

OBJETIVO: Avaliar a prevalencia de transtornos mentais em pacientes em cumprimento de medida de seguranca por crimes de natureza sexual e nao sexual. METODO: Foram analisados 89 prontuarios de pacientes do sexo masculino internados no periodo de marco de 2005 a agosto de 2006. A analise consistiu na avaliacao de dois grupos de estudo assim divididos: Grupo I, composto de sujeitos que cometeram crimes sexuais, e Grupo II, formado por sujeitos que foram condenados por outros crimes que nao de natureza sexual. As variaveis analisadas foram: idade, grau de escolaridade, estado civil, cutis, naturalidade, internacoes psiquiatricas anteriores e diagnostico psiquiatrico. RESULTADOS: Entre os sujeitos do Grupo I (condenados por crimes sexuais), observou-se maior prevalencia de diagnostico de retardo mental (61,76%) e transtorno de personalidade (29,41%). Ja no Grupo II (condenados por crimes de outra natureza que nao sexual), houve predominância do diagnostico de esquizofrenia (82,93%). CONCLUSAO: Diferentemente do encontrado na literatura internacional, em nosso meio observou-se baixo indice de transtorno de personalidade entre os sujeitos estudados, o que pode ser justificado pelo fato de o sistema penal brasileiro considerar tal diagnostico apenas como perturbacao da saude mental, nao acarretando em medida de seguranca ou internacao psiquiatrica.

Parâmetros legais para a internação involuntária no Brasil

Endereco para correspondencia: Antonio de Padua Serafim. Rua Dr. Ovidio Pires de Campos, 785, 1o andar, Ala Sul – Nufor, Cerqueira Cesar – 05403-903 – Sao Paulo, SP. E-mail: apserafim@hcnet.usp.br A interface entre a Psiquiatria e o Direito, embora seja necessaria, e complexa e dificil, ja que enquanto a linguagem medica descreve o estado do paciente em uma escala que vai de grave a completamente saudavel, a linguagem juridica e binaria: o doente e capaz ou incapaz, necessita ser internado ou nao, oferece ou nao perigo1. Quando se reporta as internacoes involuntarias – aquelas feitas sem o consentimento do paciente –, a questao fica mais evidente. A essencia das justificativas de uma internacao involuntaria esta na perda da autonomia do individuo, decorrente de sua doenca mental, que o impede de compreender e entender o carater desadaptativo de seu estado2,3. Quadros psicoticos graves, cursando com delirios e alucinacoes, e casos de depressao com risco de suicidio ilustram bem essa condicao2. Ha ainda outros quadros psiquiatricos que, mesmo nao apresentando desorganizacao das funcoes psiquicas como a consciencia e o pensamento, muitas vezes demandam internacao contra a vontade do paciente, como nos transtornos alimentares4. A maioria dos paises desenvolveu legislacoes especificas para tratamentos involuntarios, porem nenhuma dessas orientacoes contempla em sua totalidade os procedimentos, criterios, condicoes e patologias que sejam aceitas sem contestacoes5. Alem disso, os dados de literatura nao sao consistentes quanto a taxa de pacientes que apresentam incapacidade para decidir sobre ser submetido ou nao a um determinado tratamento6. Faz-se necessario, portanto, analisar brevemente o estado da legislacao brasileira concernente as internacoes psiquiatricas. A Lei Federal 10.216/20017, promulgada pelo entao presidente Fernando Henrique Cardoso, como deixa explicito em seu subtitulo, se dispoe a proteger os direitos das pessoas portadoras de transtornos mentais e redirecionar o modelo assistencial em saude mental. Ela veio em substituicao ao Decreto 24.559, de 1934, que ate entao dispunha “sobre a assistencia e protecao a pessoa e aos bens dos psicopatas”8. Desnecessario dizer que tal lei era cheia de anacronismos e inadequacoes acumuladas diante dos quase cem anos de avanco do conhecimento medico que ela atravessou. Assim, muito embora algumas medidas propostas como “redirecionamentos” para a assistencia sejam passiveis de questionamento, em seu computo geral e uma lei que trouxe avancos na regulamentacao de atos medicos envolvendo pacientes portadores de transtornos mentais. Com relacao as internacoes psiquiatricas, a lei define suas modalidades, bem como suas justificativas. No paragrafo unico do artigo 6o define-se que: “Sao considerados os seguintes tipos de internacao psiquiatrica: I – internacao voluntaria: aquela que se da com o consentimento do usuario; II – internacao involuntaria: aquela que se da sem o consentimento do usuario e a pedido de terceiro; e III – internacao compulsoria: aquela determinada pela Justica.”

Cardiac response and anxiety levels in psychopathic murderers

OBJECTIVE To compare the emotional response and level of anxiety of psychopathic murderers, non-psychopathic murderers, and nonpsychopathic non-criminals. METHOD 110 male individuals aged over 18 years were divided into three groups: psychopathic murderers (n = 38); non-psychopathic murderers (n = 37) serving sentences for murder convictions in Maximum Security Prisons in the State of Sao Paulo; and non-criminal, non-psychopathic individuals (n = 35) according to the Psychopathy Checklist-Revised. The emotional response of subjects was assessed by heart rate variation and anxiety level (State-Trait Anxiety Inventory) after viewing standardized pictures depicting pleasant, unpleasant and neutral content from the International Affective Picture System. RESULTS Psychopathic murderers presented lower anxiety levels and smaller heart rate variations when exposed to pleasant and unpleasant stimuli than nonpsychopathic murderers or non-psychopathic non-criminals. The results also demonstrated that the higher the score for factor 1 on the Psychopathy Checklist-Revised, the lower the heart rate variation and anxiety level. CONCLUSION The results suggest that psychopathic murderers do not present variation in emotional response to different visual stimuli. Although the non-psychopathic murderers had committed the same type of crime as the psychopathic murderers, the former tended to respond with a higher level of anxiety and heart rate variation.

Psychopathic traits in young offenders vs. non-offenders in similar socioeconomic condition

OBJECTIVE To analyze the differences in psychopathic traits between offender and non-offender youths with similar socioeconomic backgrounds. METHOD The Psychopathy Checklist Revised (PCL-R) scale was used to identify whether 39 young offenders with no history of mental disorders or criteria for psychopathy exhibited differences in its total score, and specifically for factor 1 or factor 2 of this scale, when compared with 32 other young people, living in similar socioeconomic conditions, who had not committed offenses. RESULTS We observed statistically significant between-group differences (p < 0.01) in mean PCL-R scores, with a mean score of 13.4 in the offender group vs. 2.1 in the non-offender group. We also detected significant between-group differences when we analyzed mean factor 1 (p < 0.01) and factor 2 (p < 0.01) scores separately. Although the groups exhibited statistically significant difference in educational attainment, between-group comparison of mean PCL-R scores controlling for educational attainment by analysis of covariance (ANCOVA) showed that the difference in PCL-R scores remained statistically significant (p < 0.01). CONCLUSIONS We conclude that, in this sample, the presence of both primary (interpersonal/affective characteristics) and secondary (lifestyle/antisocial behavior) psychopathic traits differed between offender and non-offender youths, even when excluding psychopathy and other mental disorders from the assessments. These results suggest a need for wide-ranging interventions, not restricted to socioeconomic aspects, for the management of juvenile delinquency.

Forensic neuropsychological assessment: a review of its scope

Background Issues related to the field of mental health and justice require a multifactorial understanding of the possible causes of such issues. Objective To conduct an integrative literature review of controlled studies describing forensic neuropsychological assessment. Methods The articles were compiled and analyzed in two phases: 1) first, we retrieved all papers in PubMed by the keywords “Forensic Neuropsychology” and generated a growth curve for the subject and a cluster-based thematic distribution of publications. 2) We then conducted a curated analysis of all relevant papers indexed in Medline, PubMed and ISI, between 2000 and 2012. Results The evolution of the field during the last 15 years reveals an unstable growth pattern and three main thematic clusters. In terms of our curated analysis, a total of 390 articles were pre-selected, resulting in the selection of 44 fully-relevant studies, which comprise four main categories: cognitive damage in forensic psychiatric patients; imitation of cognitive damage; civil capacity, penal liability and violence risk; and validation of neuropsychological assessment tools. Discussion Two aspects appeared as the most relevant in this study: growth in the use of neuropsychological assessment as a diagnostic tool in the forensic context; and the necessity to enhance conformity in assessments.

Personality traits and violent behavior: A comparison between psychopathic and non-psychopathic male murderers

The relationship between psychopathy and traits of temperament and character in a specific population of criminals, such as murderers, has not been sufficiently investigated. This study assesses the relationship between psychopathy and temperament and character traits in murderers. The sample consisted of 118 men divided into three groups: psychopathic murderers (N=40), non-psychopathic murderers (N=40) and 38 non-psychopathic non-criminals (controls). All individuals were evaluated by Psychopathy Checklist Revised (PCL-R) and The Temperament and Character Inventory (TCI). Psychopathic murderers presented higher scores than the other two groups in PCL-R; both criminal groups presented higher scores than non-psychopathic non-criminals. Psychopathic murderers showed lower scores than non-psychopathic murderers on Harm Avoidance, Reward Dependence, Persistence, Self-Directness and Cooperativeness. There was no difference between murderers groups regarding Novelty Seeking and Self-transcendence. In all TCI personality traits psychopathic and non-psychopathic murderers showed scores lower than controls, except Harm Avoidance for non-psychopathic murderers. In conclusion, most personality traits assessed by TCI were associated with psychopathy, while Novelty Seeking and Self-transcendence were associated with homicidal behavior independently of the psychopathy.

Dimensional Assessment of Psychopathy and Its Relationship with Physiological Responses to Empathic Images in Juvenile Offenders

Objective: Many psychophysiological studies investigate whether psychopaths present low levels of electrodermal activity (EDA). However, despite evidence that varying degrees of psychopathy are normally distributed in the population, there is a paucity of EDA studies evaluating dimensionally. Moreover, although lack of empathy is a cornerstone of psychopathy, there has been a lack of studies using pictures of empathic emotional content to assess psychophysiological responses. Method: We studied a population of young male delinquents (n = 30) from a detention center, using the Psychopathy Checklist Revised (PCL-R) to determine if higher levels of psychopathy were related to lesser degrees of EDA in response to emotion-eliciting pictures of empathic content. Results: There were significant correlations (p < 0.05) between latency and peak of EDA responses to unpleasant pictures and factor 1 scores, as well as between lability of EDA responses and factor 2 scores. Conclusion: These results extend previous findings indicating direct relationship between EDA and psychopathy, and suggest that separate investigations of the two PCL-R factors have the potential to unravel more complex relationships between EDA and psychopathy. Also, by demonstrating such associations using emotion-provoking stimuli with empathic content, our results provide a link between levels of psychopathy and biological indices of empathic detachment.