The dangers of using diagnoses outside of established psychiatric nosology in the courtroom: Analysis and discussion of current Swiss legal precedent from a medical perspective

Schleifer, Roman; Wyler, Helen; Smith, Alexander; Heer, Marianne; Voren, Robert van; Liebrenz, Michael

doi:10.1016/j.ijlp.2022.101829

Cited by 4 publications

(2 citation statements)

References 35 publications

(38 reference statements)

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“…These patients were ordered to partake in a therapeutic measure as part of their sanction or by the correctional authorities. In the Swiss forensic system, offenders can be treated under a therapeutic measure per Article 59 (inpatient treatment), Article 63 (outpatient treatment), or on a voluntary basis [for more details see ( 29 )]. At the BFOC, treatment sessions are conducted by forensic psychiatrists and psychologists; social workers may provide additional support, but they do not engage in psychotherapeutic treatment.…”

Section: Methodsmentioning

confidence: 99%

Lost diagnoses? A multi-year trajectory of patients with childhood ADHD in the criminal justice system in Switzerland

Wyler,

van Wijnkoop,

Smith

et al. 2024

Front. Psychiatry

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BackgroundAttention-deficit/hyperactivity disorder (ADHD) is prevalent amongst offenders, increasing risks for aggressive and delinquent behaviors. Since ADHD and its symptoms can persist into adulthood, accurately diagnosing and maintaining diagnoses in offenders is crucial to ensure appropriate treatment and reduce recidivism.MethodsThis study employed a retrospective longitudinal design to investigate ADHD amongst adult offenders with a confirmed diagnosis of ADHD during childhood or adolescence at a Swiss forensic outpatient clinic between 2008 and 2021. N = 181 patient files were reviewed, including forensic expert witness assessments and treatment reports. We charted the adulthood trajectory of patients with a confirmed childhood/adolescence ADHD diagnosis, examining the course of their diagnoses.ResultsOf 181 patients, evidence indicated that 12 (7%) had an ADHD diagnosis in childhood/adolescence. In 1 (8%) of these 12 cases, the diagnosis was maintained throughout the observation period. For 4 patients (33%), a diagnosis was given in the first forensic psychiatric expert witness assessment in adulthood but subsequently dropped. In another 4 cases (33%), the diagnosis was dropped in adulthood but later re-assigned, whereas in 3 cases (25%), the diagnosis was discontinued throughout the observation period. In 50% of cases with a diagnostic change, the discontinuation of an adult ADHD diagnosis coincided with a newly diagnosed personality disorder (or vice versa).ConclusionsOur findings highlighted considerable inconsistencies in the assignment of adult ADHD diagnoses amongst offenders. Whilst ADHD remission in adulthood occurs, the diagnostic variability in our results warrants detailed scrutiny. One possibility is that ADHD has similar fluctuations to conditions like depression, as argued elsewhere. Equally, diagnoses may become “lost”, meaning they are not given even when applicable and replaced by other diagnoses. Additionally, residual symptoms may remain but beyond the diagnostic threshold. This is significant because untreated ADHD can increase re-offending risks and adverse health outcomes.

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Section: Methodsmentioning

confidence: 99%

Lost diagnoses? A multi-year trajectory of patients with childhood ADHD in the criminal justice system in Switzerland

Wyler,

van Wijnkoop,

Smith

et al. 2024

Front. Psychiatry

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show abstract

“…The political abuse of psychiatry (i.e., punitive psychiatry) involves the misuse of diagnostic procedures and coercive treatment to marginalise civil dissent and impose social controls. 1 , 2 , 3 Past instances of punitive psychiatry have been documented throughout the former Soviet Union, China, Eastern Europe, South America, and other jurisdictions. 1 The 2022 invasion of Ukraine has coincided with an alarming resurgence of these practices in the Russian Federation to suppress anti-war opposition, 3 , 4 , 5 eliciting minimal condemnation from the global medical community.…”

mentioning

confidence: 99%