A b s t r a c t Objective: To illustrate the basic characteristics of several specific personality disorders, focusing mainly in antisocial personality disorder. The differences between antisocial personality disorder and psychopathy are highlighted. Serial killers and its psychopathic aspects are also discussed. Method: A bibliographic review was completed in order to outline convergences and divergences among different authors about this controversial issue, especially those concerning the possibility of treatment. Results: While anti-social personality disorder is a medical diagnosis, the term "psychopathy" (which belongs to the sphere of forensic psychiatry) may be understood as a "legal diagnosis". It is not still possible to identify an effective treatment for serial killers. Conclusion: Personality disorders, especially of the antisocial type, still represent a formidable challenge to forensic psychiatry today. Questions as yet unanswered include the best and most humane place for patients with this condition and the nature of a standardised treatment recommendation.Descriptors: Forensic psychiatry; Antisocial personality disorders; Conduct disorders; Homicide; Antimanic agents Resumo Objetivo: Apresentar as características básicas dos diversos transtornos específicos de personalidade, mas centrando-se no transtorno de personalidade anti-social, fazendo sua diferenciação com psicopatia. O estudo ainda se propõe a abordar a figura do serial killer, apontando a presença de aspectos psicopáticos no homicídio seriado. Método: Uma revisão bibliográfica foi feita no sentido de se abordar convergências e divergências entre diversos autores sobre um assunto tão polêmico, sobretudo quanto à viabilidade de tratamento dessa clientela forense. Resultados: Enquanto o transtorno de personalidade anti-social é um diagnóstico médico, pode-se entender o termo "psicopatia", pertencente à esfera psiquiátrico-forense, como um "diagnóstico legal". Não se pode falar ainda de tratamento eficaz para os chamados "serial killers". Conclusão: Os transtornos de personalidade, especialmente o tipo anti-social, representam ainda hoje um verdadeiro desafio para a psiquiatria forense. O local mais adequado e justo para seus portadores, bem como recomendação homogênea e padronizada de tratamento são questões ainda não respondidas.
The existence of the mentally ill in prisons is a complex issue and the studies attempt to analyze aspects such as the type of disorder, sex of criminals, the opposition between incarceration and treatment, policy, harm reduction and stigma. A further study on the variables raised in this work is required, as well as examining others, to the extent that they are relevant to the various socio-economic and cultural realities.
The authors make a comparative analysis between the practice of forensic psychiatry in England and in Brazil. The purpose is to stimulate the debate about the conduction of this psychiatric specialization in both countries. It is a study specifically addressed to the criminal area and its approach is carried out based on the legal, clinical, and ethical points of view. The observations made in England may be also applied to Wales, but not to the United Kingdom as a whole, since different legislation is adopted in Scotland and Northern Ireland. It concludes that while in Brazil there is a need for a closer and more integrated relationship between Psychiatry and Law, it is equally significant to clearly define the scope and the boundaries of each of these areas, as ignoring the boundaries between the two specialties could result in the risk of their relationship becoming confused, as appears to be the case in the English context.
A b s t r a c t Objective: The study aims to approach forensic psychiatry within different contexts. It endeavors to show how this specific psychiatry science area is influenced by legal and cultural aspects. Method: The bibliography reviewed had in view understanding the different ways of how to deal with law within the psychiatric sphere, from a cultural point of view. Results: there is a great heterogeneity, of different nature (legal, political, cultural, and religious) that enrich, but at the same time makes difficult, a debate about this issue. Conclusions: there are two great obstacles to achieve a good knowledge about the practice of forensic psychiatry all over the world. The first one is represented by a heterogeneity that makes difficult its description in a comprehensible way. The second is the lack of knowledge of the cultural diverse realities. These difficulties should be a stimulus for newer studies of this characteristic. Only in this way it becomes possible to gradually increase the comprehension of this issue.Descriptors: Forensic psychiatry; Mental health; Comparative study; International law; Culture Resumo Objetivo: Este estudo visa a uma abordagem da psiquiatria forense dentro de diferentes contextos, no sentido de mostrar como essa ciência é influenciada por aspectos legais e culturais. Método: Foi feita uma revisão bibliográfica com o objetivo de apreender formas culturalmente diferentes de se lidar com a lei dentro do campo médico-psiquiátrico. Resultados: Existe uma enorme gama de fatores, de diversas naturezas (legal, política, cultural, religiosa), que enriquece e, simultaneamente, dificulta um debate sobre o tema. Conclusões: Existem dois grandes obstáculos para se adquirir um conhecimento sobre a prática, em todo o mundo, da psiquiatria forense. O primeiro diz respeito a uma heterogeneidade que dificulta sua descrição de forma clara, e o segundo se refere ao próprio desconhecimento de realidades culturalmente muito diferentes. Por outro lado, essas mesmas dificuldades devem representar um estímulo para novos estudos dessa natureza, objetivando a alcançar, pouco a pouco, uma maior compreensão da matéria.
ResumoA relação entre transtorno psiquiátrico e comportamento violento vem sendo investigada de forma cada vez mais criteriosa e novos instrumentos de avaliação de risco de violência vêm sendo desenvolvidos nas últimas décadas. Este estudo apresenta um panorama atualizado dos recursos utilizados neste tipo de avaliação, tanto clínicos quanto sistematizados, enfatizando o surgimento de novos instrumentos padronizados. O objetivo maior não está concentrado na apresentação de dados matemáticos ou pontos de corte dos checklists desenvolvidos, mas, sim, nos fatores de risco, além do transtorno mental, levantados nestes instrumentos, o que permitirá uma melhor compreensão da complexidade de tal avaliação e do grau de participação da existência de doença mental. A conclusão aponta para a importância de uma avaliação equilibrada entre o exame clínico e os fatores citados nos instrumentos padronizados, bem como para a adoção de uma postura igualmente equilibrada no sentido de não supervalorizar nem tampouco n e g l i g e n c i a r a r e l a ç ã o q u e e x i s t e e n t r e t r a n s t o r n o p s i q u i á t r i c o e comportamento violento.Palavras-chave: Psiquiatria forense, avaliação de risco de violência, periculosidade. AbstractTranscranial magnetic stimulation (TMS) is a new technique capable of stThe correlation between psychiatric disorder and violent behaviour has been investigated in an increasingly judicious manner and new tools of violence risk assessment have been developed in the last decades. The present study presents an updated overview of the resources used in such type of evaluation, both clinical and systematic ones, focusing on the development of new standardized
The authors conclude that the existence of limits and internal and external controls is fundamental for a professional medical practice of quality. However, the excess of controls, which causes a defensive attitude, may negatively interfere in the quality of the care offered to patients.
The authors conclude that the discussion on the ethics of forensic expertise should be more comprehensive. The debate should include the search for equilibrium between objectivity and subjectivity, inherent to forensic expertise work, and also the utilization of advanced technological resources, always bearing in mind the conditions to which the examiner and examinee are subjected.
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