Jose Taborda

Mental illness, discrimination, and the law : fighting for social justice

This book describes clearly how legislation can be used to advance the rights and entitlements of people with mental health problems. Straightforward and practical, it provides useful information on how to address disabilities so these people may enjoy full citizenship. It presents the key issues succinctly and illustrates these with legislative examples from around the world. This book documents the role that law can play, at all levels, in combating such discrimination and abuse.

Ethics in forensic psychiatry.

Purpose of review After describing the main ethical problems in the field of forensic psychiatry, articles published from May 2001 to the present are reviewed. Forensic psychiatry is a fertile ground in which ethical and legal problems exist, and to be updated with these issues is a fundamental task for forensic practitioners. Recent findings This review covers the current discussion on the ethical framework of the specialty, the evolution of the duty to protect, the competence and capacity assessment, the new legislation on euthanasia and physician-assisted suicide, and the ethical problems of psychiatric research. Summary It is concluded that more attention should be paid to improvements in the field, as the discussion is still very limited and there have been no major advances. Critical issues, such as the development of the ethical framework in the forensic field and research with prisoners, are in need of development.

Forensic Medicine in the Next Century: Some Ethical Challenges:

The authors, after having defined the concepts of ethics, morality, and legality, debate the main ethical problems that forensic medicine will face in the next century. The authors foresee that the technological advancement will present imposing challenges, including those concerning genetic manipulation and the keeping of confidentiality regarding electronic files. On the other hand, old problems will recur, the most important being the vital question of research with prisoners and the use of torture by agents of the state. The authors also discuss the role of the forensic physician in these contexts and conclude that there is a need for international legislative mechanisms that would establish a set of explicit rules of behavior, thus diminishing the possibility of ethical dilemmas.

Accuracy of the Historical, Clinical and Risk Management Scales (HCR-20) in predicting violence and other offenses in forensic psychiatric patients in Brazil.

BACKGROUND Assessing the risk of violence is a complex task. In Latin America it is often based on clinical criteria that are not very objective or structured. HCR-20 has been used to increase the accuracy of this exam. AIMS The aim of this study was to examine the predictive validity of the Historical, Clinical and Risk Management Scales (HCR-20) violence risk assessment scale on a sample of Brazilian male forensic psychiatric inpatients. METHOD A concurrent prospective cohort design was used. The cohort was selected among the population of inpatients in Unit D (N=68) at Instituto Psiquiátrico Forense Mauricio Cardoso (IPF), Brazil. For the baseline assessment the following instruments: HCR-20-Assessing Risk for Violence, Version 2, and Hare Psychopathy Checklist, Revised (PCL-R) were used. During the one-year follow up, episodes of violent and/or anti-social behavior were assessed, and recorded on the Yudofskys Overt Aggression Scale (OAS) and Tengström et al.s Follow-Up Questionnaire. The accuracy of HCR-20 and PCL-R to predict violent and/or anti-social behavior was assessed. RESULTS AND CONCLUSIONS For the whole cohort, the mean total score of PCL-R was 13.54 and of HCR-20 it was 23.32. The rate of recidivism in the twelve month follow up was 73.5%. Outstanding among the risk factors explored for their predictive efficacy are scale HCR-20 and subscale H for any event, and scale HCR-20 for a violent event. The predictive efficacy of scales HCR-20 and PCL-R was greater for any antisocial event than for a violent event. By taking into account the possibility of recidivism and the probability of recidivism accumulated over time, instruments HCR-20 and PCL-R behaved as expected. In all these explorations, the instruments significantly differentiated the group of the sample that recidivated earlier.

Sexual disorders and crime.

Purpose of review Highlighting the relationship between sexual disorders and crime, reviewing and summarizing the articles published throughout 2011 which add to the current knowledge on this subject. Recent findings Studies on specific populations confirm the association between sexual disorders and crime, particularly between paraphilias and sexual crimes regarding male offenders. Female offenders are less likely to be diagnosed with a sexual disorder. Some case reports focus on unusual paraphilias and lead us to question the vast possibilities of paraphilic contents and sexual arousal patterns. The variations of paraphilic-associated sexual arousal patterns, unconventional sex behaviors or paraphilic disorders are constantly changing. In this sense, the American Psychiatric Associations DSM-5 current proposals for a sexual dysfunction diagnostic category are under intense discussion because of their important clinical and forensic consequences. Summary Sexual violence is a theme not well understood yet. Because of its nature, researching it can raise many ethical problems. There is no possibility of clinical trials and of case–control studies. Even cohort studies may be problematic in themselves. So, most of the research involves biased samples or case reports, or is merely theoretical. Further research is needed to improve our understanding of the subject, so that preventive and rehabilitative measures can be taken.

Serum concentrations of brain-derived neurotrophic factor and mental disorders in imprisoned women

OBJECTIVE Mental disorders and early trauma are highly prevalent in female inmates. Brain-derived neurotrophic factor (BDNF) plays an important role in learning, memory processes, and mood regulation. The aim of this study was to evaluate the relationship between serum BDNF levels and mental disorders among imprisoned women as compared with age- and education-matched controls. METHODS A consecutively recruited sample of 18 female prisoners with mental disorders was assessed for sociodemographic, criminal, and clinical variables using standardized instruments, the Mini International Neuropsychiatric Interview Plus (MINI Plus), and serum BDNF levels. RESULTS High rates of childhood sexual abuse and posttraumatic stress disorder (PTSD) were found in the group of forensic patients. Serum BDNF levels in the forensic group did not differ from those of healthy controls, and were significantly higher when compared with those of women with mental disorders hospitalized in a general hospital. CONCLUSION Elevated serum BDNF levels were found in imprisoned women. The results of this study may suggest neurobiological mechanisms similar to those seen in previous clinical and preclinical studies showing the involvement of BDNF in the pathophysiology of PTSD.

Attempted Serial Neonaticides: Case Report and a Brief Review of the Literature

Neonaticide is an infant murder occurring on the day of birth. The case reports found in the literature are often focused on the mother as the agent in the context of pregnancy denial, dissociative symptoms, or psychosis. However, this report describes a rare case of attempted serial neonaticides, in which the acts were committed by a nurse at the nursery of a referral hospital in Brazil. The authors describe a forensic psychiatric evaluation for criminal responsibility and correlate the information from this particular case with relevant forensic themes, namely neonaticide, Munchausen by proxy syndrome, and serial healthcare killers.

Public health system and psychiatry in the treatment of 'dangerous' young offenders in Brazil

We describe the Experimental Health Unit, a special forensic mental health facility in Brazil, created by court order and administered by the São Paulo Department of Health. It was designed for young offenders receiving compulsory inpatient treatment for severe personality disorders. All nine patients admitted to date came from Foundation CASA (a socio-educational centre of assistance for adolescents, the juvenile correctional centres managed by the São Paulo state Department of Justice). The court decision is questionable, relying on a new interpretation of the Child and Adolescent Statute and the law that regulates psychiatric treatment in Brazil. The public health system and psychiatry have been supporting the isolation of some individuals from society, based on the seriousness of their crimes and possession of particular personality characteristics. The decision to commit and send a small group of personality disordered individuals to this unit as inpatients is an unfair decision, since jails and correctional centres hold a high number of psychopathic who have also committed barbaric crimes. The central mental health issue is the role that the public health system should play in the custody of dangerous people; the cost-effectiveness of this model, the accuracy of risk assessment and tractability of people with severe personality disorders are also debatable. From a legal perspective, the operation of this facility raises questions about age of legal majority, the maximum period of incarceration of young offenders and use of whole-life sentences for certain types of crimes and criminals in Brazil.

Ethical Issues in Prison Psychiatry: Forensic Mental Health Care in Brazil

Brazil follows the European continental law tradition based on Roman Law, which, together with English common law, constitutes the predominant legal system in the Western world (Taborda 2004).