R. Rinaldi

Medico-legal notes for a new set of standards in the assessment of penal liability in psychiatry

Negligence liability on the part of a psychiatrist belongs among high-complexity fields, for both the judge and his or her technical consultants. In most instances, there are no scientific grounds in order to ascribe with reasonable certainty liability to medical personnel and nursing staff, while often judges tend to stretch the concept of “protection” to a degree to which the psychiatrist is deemed to have a legal obligation to stave off the development of any adverse consequence which psychic distress may bring upon the patient. The case-records pertaining to suicide are symptomatic of such a tendency on the part of the Supreme Court as to convict healthcare professionals, the lack of incontrovertible evidence notwithstanding. The authors of this paper expound and elaborate on the conditions needed to ascribe liability to the psychiatrist, and the cause and effect relationship between the doctor’s professional behavior and the patient’s eventual suicide. On such basis, several sentences are perused in which the failure to institutionalize, the discharging of a patient, the granting of leaves and an obligation to supervise all come into play, highlighting how suicide is far too complex an outcome to be rationalized into the principle of causality beyond the reasonable doubt, as dictated by the criminal procedure codes, neither can it be kept from happening through the patients’ loss of personal liberty. Within such a legal framework, what becomes apparent is the inadequateness of any set of standardized rules and laws regulating professional liability, and its inability to properly take into account the complexities and peculiarities inherent to psychiatry. Consequently, a proper overhaul of such proceedings appears to be urgent, via a newly devised set of provisions, crafted to provide a new array of undisputable, basic behavioral standards, the breaching of which would entail the sanctioning on the part of the lawful authorities of such violations, even in absence of the suicide of a patient, or persisting the inability to demonstrate a cause-effect relationship.

Demographic variables, clinical aspects, and medicolegal implications in a population of patients with adjustment disorder

Introduction Although adjustment disorder (AD) is considered as residual diagnosis and receives little attention in research, it plays an important role in clinical practice and also assumes an increasingly important role in the field of legal medicine, where the majority of diagnostic frameworks (eg, mobbing) often refer to AD. Our study aimed to look for specific stressor differences among demographic and clinical variables in a naturalistic setting of patients with AD. Methods A restrospective statistical analysis of the data of patients diagnosed with AD from November 2009 to September 2012, identified via manual search from the archive of the outpatient setting at the University Unit of Psychiatry “A. Fiorini” Hospital, Terracina (Latina, Italy), was performed. Results The sample consisted of 93 patients (46 males and 47 females), aged between 26 and 85, with medium–high educational level who were mainly employed. In most cases (54.80%), a diagnosis of AD with mixed anxiety and depressed mood was made. In all, 72% of the sample reported a negative family history for psychiatric disorders. In 22.60%, a previous history of psychopathology, especially mood disorders (76.19%), was reported. The main stressors linked to the development of AD were represented by working problems (32.30%), family problems (23.70%), and/or somatic disease (22.60%) with significant differences with respect to age and sex. Half of the patients were subjected to a single first examination; 24.47% requested a copy of medical records. Conclusion Confirming previous data from previous reports, our results suggest that AD may have a distinct profile in demographic and clinical terms. Increased scientific attention is hoped, particularly focused on addressing a better definition of diagnostic criteria, whose correctness and accuracy are critical, especially in situations with medicolegal implications.