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Relationship between homicide and mental disordersRelação entre homicídio e transtornos mentais A b s t r a c t Objective: Several studies have found a relationship between severe mental disorders and violence. One of the approaches to study this theme are investigations with homicide offenders. The aim of the present article was to investigate the association between homicide and mental disorders. Method: A review of the literature was made through the following databases: Medline, Scientific Eletronic Library Online and Lilacs. In the Medline system, it was also searched the related articles section. Results: Although there is an association between mental disorders and homicide, it is not clear why some patients behave violently and others do not. Comorbid alcohol/drugs disorders and personality disorders and lack of adherence to treatment may increase this risk. Conclusions: Identifying people with risk of violence and offering them mental health treatment services is warranted. These services should prevent the loss of contact and non-compliance with treatment that frequently precede homicide committed by people with severe mental disorders. It is of utmost importance that society and governmental authorities decrease the barriers that limit access to psychiatric and psychosocial treatment.

Objectives: To evaluate factors related to dangerousness cessation at the end of involuntary commitment based on an analysis of expert reports. In light of the current legal requirement of dangerousness cessation as a pre-requisite for prison or internment release of individuals subjected to the safety measure, we sought elements to reflect on the practice of expert examiners in charge of making this decision. Methods: The authors revised 224 expert psychiatric dangerousness cessation reports released 2011 through 2014 and collected data for a statistical analysis. Results: The following variables were associated with positive risk cessation assessments: no inadequate behavior (according to the assistant professionals), no productive psychotic symptoms, no negative symptoms, presence of insight, presence of a support network, and no psychoactive substance abuse. The following variables were associated with negative dangerousness cessation decisions: early onset of malfunction, lack of insight, negative attitudes, active signs of major mental illness, presence of impulsiveness, poor response to treatment, presence of plans lacking feasibility, exposure to destabilizing factors, lack of personal support, and presence of stress. Conclusions: In this study we were able to identify factors associated with dangerousness in a sample of expert reports. The knowledge of factors linked to a higher risk of recidivism in illegal activities or violent behavior is crucial for decision-making regarding the release of offenders after their legally established period of involuntary commitment.

The goal of the current study was to investigate the socio‐demographic, psychiatric, and criminological characteristics of female violent offenders with mental disorders involuntarily committed to a forensic psychiatric hospital. The present study was a population‐based retrospective case series including all female offenders with mental disorders found not guilty by reason of insanity by the criminal courts in the state of Rio de Janeiro, Brazil, and involuntarily committed to a forensic psychiatric facility (n = 27). Patients were assessed with Structured Clinical Interview for DSM‐IV Axis I Disorders and the Positive and Negative Syndrome Scale. We found that most offenders were Afro‐Brazilian, uneducated unmarried women. Schizophrenia with active psychotic symptoms was the most common clinical condition. Relatives were the frequent victims of aggressive behavior. Most patients had already been diagnosed with a mental disorder and placed under psychiatric treatment, but poor adherence and treatment dropout were common. Violent behavior in psychiatrically ill female patients is associated with a specific socio‐demographic and clinical profile and is thus potentially amenable to prevention particularly if the mental health and social services are to provide the much‐needed support for economically, socially, and psychologically vulnerable women.

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Introduction The World Health Organization (WHO) Department of Mental Health and Substance Abuse appointed a Working Group on Sexual Disorders and Sexual Health in order to revise and propose changes to ICD-10 categories. Aim Analyze ethical and legal implications in Brazil of the proposed ICD-11 diagnostic criteria for paraphilic disorders. Methods A forensic working group of Brazilian experts in collaboration with representatives of WHO reviewed the proposed modifications to the classification of Disorders of Sexual Preference in ICD-10 (F65), which is recommended to be replaced by Paraphilic Disorders in ICD-11. Proposals were reviewed through a medicolegal lens, using a legal and policy analysis guide put forth by WHO. The premise of this review was to understand that, although the ICD classification is intended to provide a basis for clinical and statistical health interventions, medical diagnostics may also be entangled in the complex legal, normative, and political environment of various countries. Main Outcome Measure The most important proposed change to this section is to limit the concept of paraphilic disorders primarily to patterns of sexual arousal involving a focus on others who are unwilling or unable to consent, but this change has not affected the ethical and legal aspects of psychiatric functioning in the Brazil. Results Because Brazilian criminal law is directed toward criminal behavior and not to specific psychiatric diagnoses, the changes proposed for ICD-11 are not expected to create obstacles to health services or to modify criminal sentencing. Clinical Implications Although ICD-11 has a number of changes in its content, there are no significant clinical implications in the Brazilian context, but a better clarity of conceptual definitions and diagnostic criteria. Strengths & Limitations The study is conducted with people from different Brazilian states, which is important for a comprehensive view. On the other hand, considering that it is a very heterogeneous country, there is the limitation that an even wider scope of the study is not possible. Conclusion In the Brazilian context, the new guidelines for paraphilic disorders contribute to clinical utility and are not expected to create difficulties related to the legal, social, and economic consequences of sexual offenses in the country.

rESUMoO objetivo do presente artigo é discutir os conceitos de periculosidade e responsabilidade penal, por meio do relato de caso de uma paciente com diagnóstico de retardo mental que cometeu homicídio. Ela foi submetida à medida de segurança detentiva em hospital psiquiá-trico de custódia e segurança, na cidade do Rio de Janeiro, Brasil. Este relato demonstra a importância da psicopatologia e da psiquiatria na prática forense, auxiliando o magistrado na determinação da responsabilidade penal do indivíduo portador de transtorno mental ou retardo mental. O estudo do comportamento violento em indivíduos com transtornos psiquiátricos pode contribuir para o seu entendimento, prevenção e tratamento. aBStraCt The objective of this article was to discuss the concepts of dangerousness and penal responsibility, through the presentation and analysis of the case of a patient with a diagnosis of mental retardation who committed murder. She was found not guilty by reason of insanity and was criminally committed to a forensic hospital in the city introDUÇÃoNo Direito Penal, periculosidade é a probabilidade de o agente vir ou tornar a praticar ato previsto como crime. Pode ser presumida pela lei e, assim, resultar na aplicação compulsória de medida de segurança ou ser reconhecida pelo juiz. A medida de segurança fica reservada ao agente inimputável, podendo ser de dois tipos: a detentiva, que determina a internação em hospital de custódia e tratamento psiquiátrico, e a restritiva, na qual o tratamento psiquiátrico é em regime ambulatorial. Seu prazo de duração varia de um a três anos, sendo esse tempo determinado por autoridade judicial e dependente da natureza (gravidade) do ato praticado. A medida de segurança só pode ser interrompida após o término desse prazo e com a constatação de cessação de periculosidade, por meio do laudo pericial.