ABSTRACT Background: Psychiatric disorders cause significant impact to the individual, leading to lack of productivity and involvement with the legal system. Objectives: The present study aims to determine the association of mental disorders and an individuals’ odds of involvement with the legal system Methods: Through a descriptive cross-sectional study, 126 patients selected according to convenience sampling were interviewed for the study on their appointment days at University of São Paulo School of Medicine hospital. They were divided into a case group (n = 63) with patients from the outpatient clinic of the Department of Psychiatry and a control group (n = 63), with patients from the outpatient clinic of Department of Internal Medicine. These patients were asked to answer a questionnaire on sociodemographic information, age, medical diagnosis, and legal proceedings as related to their diagnoses. Results: We found high difference between the groups, in longer absences 57.10% of psychiatric patients, with only 33.3% in clinical group. This difference also appears in the requirement for forensic medical exams - 65.1% of psychiatric patients versus 44.4% of clinical patients. Discussion: This data clearly shows that involvement of psychiatric patients in legal matters is quite common, and therefore it is increasingly important for psychiatrists to be aware of legal implications when evaluating their patients.

SUMMARY OBJECTIVE: It is not uncommon for medical residents to deal with critically ill patients who frequently show several ethical and human dilemmas, highlighting the need for a consultation with ethical specialists. The objective of this article is to present a description of a Brazilian Ethics Consultation group designed to attend psychiatry residents. METHODS: This article reports a case of a critically ill patient with Borderline Personality Disorder with multiple intervention failures and several ethical conflicts who was seen by a resident and supported by an ethics consultation group. RESULTS: When medical residents and medical staff face severe and unusual ethical dilemmas, they might feel unprepared and have ones’ mental health impaired. Thus, this article reports a successful ethics consultation and discusses its development in other academic institutions. CONCLUSION: Medical educators and staff from academic hospitals should pay attention to the needs of the medical residents. The development and support of ethics consultation groups must be provided to fulfill the need of those residents who face serious ethical and human dilemmas.

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.

Assuntos relacionados à saúde mental na corte vêm demandando crescente participação de psicólogos. Sob este mote, apresentamos uma aplicação de um assessment neuropsicológico em um caso de reversão de aposentadoria por invalidez. Trata-se do caso de um juiz de 35 anos, que chegou à nossa Unidade de Tratamento Forense Psicológico e Psiquiátrico, no Hospital das Clínicas da Universidade de São Paulo. Para suprir a demanda, inicialmente conduzimos uma entrevista clínica e, em seguida, aplicamos uma bateria neuropsicológica, a partir da qual foi revelada a inexistência de limitações do desempenho cognitivo, as quais recomendariam a reafirmação do afastamento do profissional. Tal como revelado, o uso adequado do assessment neuropsicológico mostra-se uma importante ferramenta em contexto forense, auxiliando o esclarecimento de aspectos funcionais do diagnóstico, em vários contextos psicopatológicos.

Issues related to mental health in relation to court matters have increasingly required the participation of the psychologist. We present the use of forensic neuropsychological assessment in a case of retirement reversal. Incapacity was attested due to disability resulting from depression of a 35-year-old attorney, and the case was forwarded from the courts to the Forensic Psychiatry and Psychology Unit at the USP Clinical Hospital. A clinical interview and application of cognitive tests was conducted. Despite the depression, significant cognitive losses that would prevent return to his professional assignments were not detected. The neuropsychological assessment has been shown to be an important tool in the forensic context, as it assists with diagnostic value for clarification of functional aspects in the various psychopathological areas in terms of disabilities or potentialities.

Diversos estudos revelam que jovens infratores encarcerados apresentam taxas aumentadas de transtornos psiquiátricos, ao passo que associações entre transtornos específicos e reincidência permaneçam desconhecidas. O sistema legal brasileiro criou uma oportunidade exclusiva para o estudo desta questão, conforme considera os menores não imputáveis, a despeito da severidade do crime, fixando em três anos o período máximo de encarceramento. Este estudo pretende determinar a taxa de transtornos psiquiátricos em uma coorte de jovens infratores encarcerados e avaliar possíveis conexões entre transtornos específicos encarceramento primário e reincidência criminosa. Um grupo de 898 internos da Fundação Casa foi submetido a entrevistas psiquiátricas e diagnosticado de acordo com os critérios do CID-10. Conexões estatísticas foram analisadas usando os testes de Pearson e Cramer. A coorte tinha 619 primários e 267 reincidentes. Uso de Substância Psicoativa e Desordens da Personalidade e Comportamento Adulto relacionaram-se com reincidência, ao passo que Doenças Mentais Orgânicas, Transtorno do Humor e Desordens Relacionadas ao Estresse apresentaram relação com encarceramento primário. No que tange aos preditores da criminalidade, reforça-se a noção de que o abuso de drogas é a principal causa de encarceramento na amostra investigada.

Several studies report that incarcerated young offenders show a high rate of psychiatric disorders whereas associations between specific psychiatric disorders and recidivism remain unknown. The Brazilian legal system has created a unique opportunity for the study of this issue when consider young offenders not that guilty in spite of the severity of the crime, settling in three years the maximum period of incarceration. This study aims to determine the rate of psychiatric disorders in a cohort of incarcerated young offenders and evaluate the possible psychiatric connections of primary offenders and recidivism. A group of 898 incarcerated young offenders at Fundação Casa answered psychiatric interviews and was diagnosed according to the criteria of ICD-10. Statistic connections were analyzed using the tests of Pearson and Cramer. The cohort was comprised of 619 primaries and 267 recidivists. 'Psychoactive Substance Use' and 'Disorders of Adult Personality and Behavior' categories were related to recidivism, whereas 'Organic Mental Disorders', 'Mood Disorders', and 'Stress-related Disorders' were related to primary offenders. Discriminating disorders were the most likely to represent reactions to primary incarceration. In relation to associations that might represent predictors of crime, it became highly suggestive that substance abuse is the main cause of incarceration for the entire cohort.

CONTEXTO: A relação entre transtorno mental e histórico de abuso sexual é frequentemente observada na prática clínica e relatada na literatura. OBJETIVO: Descrever os dados demográficos e os aspectos emocionais e comportamentais em crianças e adolescentes vítimas de abuso sexual. MÉTODO: 205 crianças 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) vítimas de abuso sexual passaram por avaliação psicológica e psiquiátrica individual no período de 2005 a 2009. As variáveis estudadas foram: gênero, faixa etária, grau de relação da vítima com o perpetrador, aspectos psicológicos, dados psiquiátricos, aspectos comportamentais e afetivo-emocionais (culpa, vergonha, medo, insegurança, percepção da figura masculina e feminina e de si em relação ao ambiente). RESULTADOS: As meninas são as maiores vítimas (63,4%). A faixa etária de maior risco para as meninas é entre 7 e 10 anos de idade (48,5%), enquanto para os meninos é de 3 a 6 anos (54,6%). Os pais são os maiores perpetradores do abuso sexual (38%), seguidos do padrasto (29%). Meninos e meninas expressaram elevada frequência para depressão e transtorno de estresse pós-traumático (TEPT). As meninas expressam comportamento mais erotizado, enquanto os meninos ficam mais isolados. CONCLUSÃO: Este estudo permitiu identificar uma parcela relevante de aspectos psicológicos, psiquiátricos e comportamentais, os quais podem afetar de forma impactante o desenvolvimento emocional de crianças e adolescentes.

BACKGROUND: There is a well known relationship between sexual abuse in children and mental health disorders, which is seen both in clinical practice as in the scientific literature. OBJECTIVE: To describe demographic profile as well as behavioral and emotional features of a cohort of children and adolescents sexually abused. MÉTODO: 205 children and adolescent, ranging from 6 to 14 years old, 130 girls (age 9.6 ± 3.4 yo) and 75 boys (age 7.2 ± 2.9 yo) were evaluated due to being victims of sexual abuse between the years 2005 and 2009. Gender, age, relationship with the perpetrator, psychological and psychiatric symptoms, behavioral and affective-emotional features (blame, shame, fearfulness, male and female figures image and self perception) were all properly evaluated. RESULTS: Girls were the main victims (63.4%). The riskier age ranging from 7 to 10 yo (48.5%) among then, and from 3 to 6 yo (54.6%) for the boys. Fathers are the major perpetrators (38%) followed by step-fathers (29%). Boys and girls show high risk for depression and Post-traumatic stress disorder (PTSD) symptoms. Girls tend to be more sexualized whilst boys tend to isolate themselves. DISCUSSION: This research allowed to identify an important set of psychological, psychiatric and behavioral characteristics that affect the normal emotional development of children and adolescents.

OBJETIVO: Avaliar a prevalência de transtornos mentais em pacientes em cumprimento de medida de segurança por crimes de natureza sexual e não sexual. MÉTODO: Foram analisados 89 prontuários de pacientes do sexo masculino internados no período de março de 2005 a agosto de 2006. A análise consistiu na avaliação 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 não de natureza sexual. As variáveis analisadas foram: idade, grau de escolaridade, estado civil, cútis, naturalidade, internações psiquiátricas anteriores e diagnóstico psiquiátrico. RESULTADOS: Entre os sujeitos do Grupo I (condenados por crimes sexuais), observou-se maior prevalência de diagnóstico de retardo mental (61,76%) e transtorno de personalidade (29,41%). Já no Grupo II (condenados por crimes de outra natureza que não sexual), houve predominância do diagnóstico de esquizofrenia (82,93%). CONCLUSÃO: Diferentemente do encontrado na literatura internacional, em nosso meio observou-se baixo índice de transtorno de personalidade entre os sujeitos estudados, o que pode ser justificado pelo fato de o sistema penal brasileiro considerar tal diagnóstico apenas como perturbação da saúde mental, não acarretando em medida de segurança ou internação psiquiátrica.

OBJECTIVE: To evaluate the prevalence of mental disorders in convicted sex offenders admitted to the Psychiatric Custody and Treatment Hospital (Forensic Psychiatric Facility). METHOD: 89 patient records of males admitted from March 2005 to August 2006 were analyzed. The analysis included evaluation of two study groups: Group I comprised subjects who had committed sex offenses (sexual offenders) while Group II contained subjects convicted for other crimes (non-sexual offenders). Variables studied were: age bracket, years of schooling, marital status, skin color, place of birth, previous psychiatric admissions and psychiatric diagnosis. RESULTS: Mental retardation and personality disorders were the mainly diagnoses in Group I (sexual offenders) (61,76% and 29,41% respectively). In the other hand, schizophrenic subjects predominated in Group II (non-sexual offenders) (82,93%). CONCLUSION: Different from international data, we have found low prevalence of personality disorders among Brazilian forensic population and we believe that it's due to a distinguishing characteristic of the Brazilian legal system, which does not consider personality disorder a mental disease, thus, not prompting these patients to civil commitment.

OBJETIVO: Comparar a atividade cardíaca e nível de ansiedade de homicidas psicopatas e não psicopatas e não criminosos não psicopatas. MÉTODO: 110 homens com idade superior a 18 anos, divididos em três grupos: homicidas psicopatas (n = 38), homicidas não psicopatas (n = 37) cumprindo pena por homicídio em Prisões de Segurança Máxima do Estado de São Paulo e não criminosos e não psicopatas (n = 35) de acordo com a Escala de Avaliação de Psicopatia. A resposta emocional foi avaliada pela variação da freqüência cardíaca e níveis de ansiedade após a observação por seis segundos de imagens padronizadas de diferentes conteúdos emocionais (agradáveis, desagradáveis e neutras) do International Affective Picture System. RESULTADOS: Homicidas psicopatas apresentaram menores níveis de ansiedade e menor variação de frequência cardíaca quando expostos a estímulos agradáveis que os homicidas não psicopatas e o grupo de não criminosos e não psicopatas. Os resultados demonstram ainda que quanto maior o escore no fator 1 da Escala de Avaliação de Psicopatia, menor é a variação cardíaca e o nível de ansiedade. CONCLUSÃO: Os resultados sugerem que homicidas psicopatas não apresentam variação da resposta emocional frente aos diferentes estímulos visuais. Embora os homicidas não psicopatas compartilhem do mesmo tipo crime que os psicopatas, estes tendem a responder com maior nível de ansiedade e variação cardíaca.

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.

CONTEXTO: A prática de abuso sexual contra crianças é um fenômeno universal. Ela ocorre em todos os tempos e lugares e atinge todas as classes socioeconômicas. Enquanto a maioria dos estudos investiga as vítimas, os poucos estudos sobre agressores se concentram principalmente em dados demográficos. OBJETIVO: Apresentar revisão da literatura quanto à classificação de molestadores sexuais de crianças, de acordo com o perfil psicológico e comportamental. MÉTODOS: Revisão da literatura e discussão do material utilizado. RESULTADOS: Apresentação das principais classificações dos criminosos sexuais contra crianças, identificando as tipologias mais utilizadas com suas possíveis contribuições à psiquiatria e à psicologia forense. CONCLUSÃO: A utilização do perfil psicológico em crimes sexuais é de fundamental relevância no contexto médico-legal, mas ainda carece de bases científicas mais sólidas.

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.