责任能力与作案特征、作案时精神症状的相关分析

目的:探讨责任能力与作案特征、作案时精神症状的相关性. 方法:通过使用精神疾病患者限定刑事责任能力评定量表及简明精神病评定量表(BPRS)等工具,对504例刑事案件鉴定案例的责任能力、作案特征及作案时精神症状进行相关分析. 结果:责任能力与BPRS中精神病性症状的相关性较大(0.5相似文献   

精神病患者刑事责任能力评定量表在司法精神病鉴定中的应用

目的:探讨精神病患者刑事责任能力评定量表(RSCRs)应用于司法精神病鉴定实践中的可能性。方法:对200例刑事责任能力鉴定案例进行RSCRS评分,对暴力犯罪案件增加暴力作案刑事责任能力评定量表(CRRSV)评定,并与专家鉴定意见进行比较。结果:全量表Cronbach'sα系数为0.944,Guttmann分半信度为0.890;除条目10、11,其余各条目之间及与总分相关性尚可(r0.400,P=0.000);专家评定意见中不同等级责任能力及相互之间差异有统计学意义(F=548.038,P=0.000);探索性因素分析提取4个因子,累积贡献率为78.612%,验证性因素分析提示模型拟合度比较理想;RSCRs等级划分结果与专家鉴定意见一致性高(Kappa=0.876,P=0.000)。在暴力犯罪案件中,RSCRs和CRRSV总分高度正相关,等级一致性高(Kappa=0.873,P=0.000);判别函数回代92.5%的样本划分正确。结论:RSCRs具有较好的信效度,可用于司法精神病鉴定中作为刑事责任能力评定及分级的参考工具。     

部分刑事责任能力精神病违法者的犯罪学特征及其相关分析

目的研究在刑事案件中部分刑事责任能力精神病违法者的犯罪学特征以及这些特征与部分刑事责任能力的相关性,为司法精神病学鉴定提供客观的科学依据。方法对300例符合纳入和排除标准的研究对象使用自制的调查表进行研究,所得资料使用SPSS10.0软件进行统计分析。统计方法包括统计描述、spearman相关分析及多元成组t检验等。结果部分刑事责任能力精神病违法者犯罪时有一定的犯罪动机者为81.3%,作案前有可疑的诱发因素者占研究总体的73.0%,作案前对作案对象、工具有选择者分别占总体的64.7%和62%,59.7%对作案时间无选择,为临时起意。作案后50%的被鉴定人缺乏逃避掩盖等反侦察手段,或有可疑的反侦察行为者39.7%,无伪装75.0%或可疑伪装22%。被鉴定人的生活自理能力、工作学习能力轻度损害者分别为80.4%和74.3%。相关分析发现部分刑事责任能力与作案动机的相关系数为r=0.116(P=0.049)、与作案先兆(r=0.114,P=0.048)、作案的诱因(r=0.172,P=0.003)、作案地点选择(r=0.139,P=0.016)、作案工具选择(r=0.170,P=0.003)、作案后的反侦察手段(r=0.132,P=0.022)及自知力(r=0.293,P=0.000)。结论部分刑事责任精神病能力违法者是符合CCMD或/和ICD-10精神与行为障碍分类的精神障碍患者,作案多有犯罪动机,作案前有可疑的诱发事件,作案前对作案对象、工具有选择,作案后缺乏逃避掩盖等反侦察手段,或有可疑的反侦察行为。部分刑事责任能力精神病违法者在犯罪学特征与多项犯罪学特征呈正相关,其中与自知力和作案前诱因两项相关性较强,可将上述特征量化并结合作案当时的精神病理学特点,为部分刑事责任能力的评定提供较为客观的依据     

暴力作案刑事责任能力评定量表的应用

目的 探索暴力作案刑事责任能力评定量表（CRRS—V）对暴力作案刑事责任能力鉴定的使用价值。方法 采用CRRS—V,对155例暴力作案被鉴定人进行刑事责任能力评分,将评分结果同专家鉴定意见以及使用Rogers刑事责任能力评定量表（R—CRAS）评定的结果进行比较,分析CRRS—V的信度与效度。结果 CRRS—V量表评分者问一致性高（ICC=0．970,P〈0．001）;Cronbach系数为0．916。CRRS—V与专家结论的一致性较高（Kappa=0．880,P〈0．001）。结论 CRRS—V具有良好的信度和效度,符合量表编制的要求,具有实际应用价值。     

精神分裂症患者作案的司法精神医学鉴定分析

目的 探讨精神分裂症作案和司法精神医学鉴定的特点。方法 将102例精神分裂症患者的一般资料、鉴定资料和作案资料进行统计分析。结果 以暴力作案为主,危害行为常在妄想、幻觉等精神病性症状支配下出现,病程在3年以内多见,10年以上病程的患者作案也占有相当的比例。现症患者多被评定为无责任能力,缓解期多被评定为完全责任能力。结论 精神分裂症作案者的责任能力应根据疾病的发生发展规律和该症的作案特征作出恰当评定;应加强对患者的治疗与监护管理,并引起全社会共同关注。     

暴力作案刑事责任能力的量化评定:Ⅰ.量表的编制

目的通过编制评定工具来探索对责任能力的客观量化评定。方法总结本中心16年来暴力作案责任能力的专家鉴定资料，并结合国内外有关的鉴定理论与实践报道，参考国外的类似评定工具编制出《暴力作案刑事责任能力评定量表》(CRRSV)；根据专家鉴定经验确定评分标准，并通过对近年来鉴定资料的试评来确定界限值，最后进行初步的信、效度检验。结果CRRSV条目与国内大多数研究报道的辨认、控制能力和责任能力法学(心理学)标准相关因素一致，同时也能反映医学要件对责任能力的影响，信度和效度良好，有操作性。结论CRRSV与医学标准相结合可能对于客观地评定暴力作案的责任能力具有参考价值。     

精神分裂症患者共情能力及相关因素分析

目的 通过比较住院精神分裂症患者治疗前后共情缺陷、社会功能和精神症状的差异,探讨共情能力的相关因素及药物治疗对共情能力的影响。方法 对60例（男30例,女30例）住院精神分裂症患者予新型抗精神病药物治疗3个月,采用人际反应指针量表（IRI—C）、阳性和阴性症状评定量表（PANSS）及个体和社会功能量表（PSP）,分别对患者治疗前后的共情水平、精神症状、社会功能进行评定,比较各项测量指标前后的变化,并通过各测量指标治疗后减分率的相关分析,探讨精神分裂症患者共情能力、临床症状以及社会功能的关系,以及药物治疗对共情能力的影响。结果 精神分裂症患者予新型抗精神病药治疗3个月后,共情能力、精神症状、社会功能均有所改善。治疗前后各项评分减分率进行Pearson相关分析显示,精神分裂症患者的共情能力与阴性症状呈负相关,与社会功能呈正相关。结论 非经典抗精神病药物治疗可改善共情能力、精神症状和社会功能,精神分裂症患者的阴性症状随着共情能力的改善而改善。     

司法精神病鉴定中限定刑事责任能力评定(附95例分析)

目的：对司法精神病鉴定中评定为限定刑事责任能力进行讨论。方法：对95例司法精神病鉴定中评为限定刑事责任能力案例进行分析。结果：限定刑事责任能力的评定在鉴定中可酌情应用。结论：限定责任能力大致可见于以下几种：①精神病性症状与作案无直接关系；②继发性人格障碍而非疾病直接导致；③轻、中度精神发育迟滞；④其他精神活动障碍。     

精神分裂症患者神经系统软体征随访观察

目的:探讨缺陷型、非缺陷型精神分裂症患者神经系统软体征(NSS)的长期随访特点.方法:对1997年9月曾进行NSS评定、持续住院的缺陷型和非缺陷型精神分裂症患者分别23例和30例于4年后再次进行评定,同时采用简明精神病评定量表(BPRS)、阳性症状评定量表(SAPS)、阴性症状评定量表(SANS)评定其精神症状.结果:4年后精神分裂症患者NSS总分及顶叶、额叶、枕叶因子分均明显增加;非缺陷型患者仅顶叶、额叶因子分显著增加.NSS评分均与同期的SANS评分呈正相关,而与SAPS评分无显著相关性.结论:缺陷型精神分裂症患者NSS随病程进展呈加重趋势,其严重程度与阴性症状密切相关.     

鉴定有精神障碍的犯罪嫌疑人资料分析

目的:探讨有精神障碍犯罪嫌疑人的精神病学特点. 方法:采用自编一般资料调查表、简明精神病评定量表(BPBS),对147例涉嫌刑事案件的有精神障碍犯罪嫌疑人进行评定.147例犯罪嫌疑人被评定为无刑事责任能力组91例,有刑事责任能力组56例(限定刑事责任能力35例,完全刑事责任能力21例). 结果:有精神障碍的犯罪嫌疑人以男性、未婚、农民及小学以下文化程度居多(P<0.05或P<0.01).无刑事责任能力和限定刑事责任能力组以精神分裂症居首位;完全刑事责任能力组以物质依赖居首位;精神分裂症第2位.无刑事责任能力组案型以凶杀、伤害为主,而有刑事责任能力组则以伤害、强奸、盗窃多见(P<0.05或P<0.01).无刑事责任能力组BPRS总分及思维障碍、激活性、敌对猜疑各因子分均显著高于有刑事责任能力组(P<0.05或P<0.01). 结论:精神障碍种类、精神症状及严重程度可影响刑事责任能力的评定.     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.