中文版精神病人刑事责任能力评定量表的信度和效度研究

目的:探讨中文版《精神病人刑事责任能力评定量表》(中文版R-CRAS)的信度和效度。方法:国内12名不同省市的资深司法精神病学鉴定专家运用R-CRAS量表采用盲法对3例犯罪嫌疑人的辨认能力或者控制能力以及刑事责任能力的评定结果进行比较。结果:量表内部一致性系数(Cronbach'sα)r=0.846。12名评定者对全量表评定的一致性系数r=0.493,一致性最差的4个条目(第10、11、14、17题)占全量表的22.22%(r=0.099~0.294,P均0.05),提示这些条目与刑事责任能力评定或许没有必然联系。12名评定者36例次评定结果:部分、小部分、大部分、完全和无刑事责任能力的分别为7(19%)、2(6%)、8(22%)、15(42%)和4(11%)例次,提示评定者根据量表对刑事责任能力评定的结果明显不同。对于12名评定者的36例次的评分转换成等级资料,进行Friedman检验(χ2=208.824,df=17)和Kendall'W协同系数检验(Kendall'W系数=0.341,χ2=208.824,df=17),显著性均P=0.000,提示量表评分标准存在随意性。多维尺度分析发现,该量表条目按其相似性和差异性可以被划分为若干不同的范畴,仅以"辨认能力"和"控制能力"不能概括他们的特征。结论:中文版R-CRAS的设计欠合理,需进一步研究改进。     

Jeu d’argent problématique et responsabilité pénale

ObjectivesIn total, 14% to 30 % of individuals with gambling disorder engage in illegal acts to finance such behavior. This clinical situation could be explained by higher gambling severity, associated substance use disorder, antisocial personality disorder and economic factors (debts, financial problems). The present work focuses, more broadly, on criminal responsibility of problematic gamblers.MethodsWe will discuss this question through different typical situations that medical experts of criminal responsibility may have to face. We will address each of the following cases: 1) isolated problematic gambling; 2) problematic gambling associated with antisocial personality disorder; 3) problematic gambling associated with a manic episode; 4) problematic gambling associated with substance use disorders; and 5) problematic gambling associated wiht dopamine agonist treatment.ResultsIsolated problematic gambling, (not associated with any psychiatric or addictive disorder): it seems consensual that individuals committing infractions in this case are criminally responsible. However, impeded ability to action control and possible sentence attenuation could be discussed in case of severe gambling disorder. Problematic gambling associated with antisocial personality disorder: if the penal offence reports solely to personality disorder, criminal responsibility would be attributed. However, if illegal or violent acting is directly linked to co-cocurrent delusional symptoms, it could be a cause of criminal non-responsibility. Problematic gambling associated with manic episode: manic episode related offence could lead to negation of criminal responsibility, while a hypomanic episode may provide grounds for sentence reduction. Problematic gambling associated with substance use disorders: in France, addiction is not considered to remove nor to impede a person's ability to understand or control his actions and is excluded from criminal non-responsibility causes. However, substance induced delusional or confusional episodes could abolish a subject's discernment or his ability to control his actions yielding to penal non-responsibility. Problematic gambling associated with dopamine agonist treatment: Criminal responsibility for dopamine agonist induced gambling related illegal acts is still controversial. Nevertheless, people committing an infraction linked to associated dementia or dopamine agonist induced mania should be considered as criminally non-responsible.ConclusionsSome clinical dimensions such as craving intensity, compulsivity, disorder's severity, volitional control might be forensic targets to assess criminal responsibility.     

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。     

精神障碍者限定刑事责任能力的评定分级

目的：研究对限定责任能力进行分级的可行性。方法：根据责任能力受影响的程度将106例限定责任能力案例分为三组,对他们的作案特点和疾病严重程度进行比较分析。结果三组在作案特点和疾病严重程度上存在显著差异：小部分组多起意过程简单(92％)、作案前缺乏先兆(84％)及计划准备(84％),缺乏自我保护(64％),对作案行为的认识模糊,自知力、生活自理能力及工作学习能力受损严重;大部分组多正常起意(76．9％)、作案前有先兆(46．2％)及计划准备(76．9％),有自我保护(74．4％),对作案行为的认识较完整,有一定自知力,生活自理能力及工作学习能力受损轻;部分组则介于两者之间。结论限定责任能力可以被划分为三级。     

Clinical analysis of 47 cases of epilepsy

This article makes a clinical analyses of the general data concerning 47 epileptic cases in our hospital, and especially reports on the forensic psychiatric assessment of two out of the seven criminal cases, their history of illness and responsibility. In the assessment of such cases, special emphasis should be laid on the diagnosis of the epilepsy so as to avoid misdiagnosis. The author suggests that the patient folds no responsibility for his criminal behaviour during the attack. But he should be responsible in a diminished criminal for his criminal behavior when he is only suffering from a personality disorder, since he has some discriminative and self-control ability.     

Criminal responsibility assessment in Switzerland: changes and continuity

BACKGROUND: The factors that experts use to assess criminal responsibility are not very well known. Changes in the importance attributed to certain diagnoses are occasionally mentioned in the literature. The aim of this study is to identify the existence and the nature of such modifications. METHOD: We compared the socio-demographic, criminological and psychiatric characteristics of two samples of psychiatric assessments carried out in Geneva, Switzerland in 1973-74 (N = 75) and 1997-98 (N = 94). RESULTS: The two groups of subjects described by the experts' reports appear to be quite different in several characteristics. However, the rate at which experts conclude their reports in favour of diminished responsibility was not found to be significantly different. The logistic regression shows that the diagnosis of personality disorder is the only variable that influenced the experts differently for the 1997-98 period compared to the 1973-74 period. CONCLUSION: In Geneva, psychiatric experts still continue to ascribe diminished responsibility to offenders suffering from psychosis or depression. However, the population that undergoes psychiatric assessments nowadays has changed considerably.     

Psychiatry and the criminal justice system: testing the myths

Several states are changing legislation and treatment programs for mentally ill offenders without knowing how current laws and programs operate. To address this problem the authors linked data from police records, court reports, and clinical files for 2,735 psychiatric referrals from the criminal justice system of Alaska from 1977 through 1981. They found that only 0.2%-2.0% of all schizophrenic persons in the community were arrested for violent crimes each year, accounting for 1.1%-2.3% of all arrests for violent crimes; that psychiatrists agreed about competency and responsibility in 79% of the cases evaluated by more than one clinician; and that a successful insanity defense occurred in 0.1% or less of all criminal cases.     

Psychiatric and psychological evidence in the Supreme Court of Iceland—2001 to 2007

Background: Little is known about expert psychiatric and psychological evidence in appeal cases. Aims: To review the frequency, nature and impact of expert psychiatric and psychological evidence in the Supreme Court in Iceland over a 7-year period where all appeals in Iceland are heard. Method: All cases listed on the Supreme Court's Website between 2001 and 2007 were identified. The judgements were carefully screened for relevant information. Details of the nature of the criminal offences for the sample were obtained from official records. Results: 3367 cases were identified. Psychiatric and psychological evidence was considered in 213 (6.3%) cases (2.7% and 4.2% for the two disciplines, respectively), with only 10% cases involving reports from both disciplines. Psychiatrists focused primarily on assessing violent offenders, diminished responsibility issues, restraining orders, and mental state examinations and diagnosis, whereas psychologists were more commonly involved in custody disputes and credibility assessments of victims of sexual offending. No oral expert evidence was heard in the Supreme Court. Psychiatric and psychological evidence was typically that previously presented in the District Courts. Conclusions: This is the first comprehensive study to investigate the contribution of forensic psychiatry and psychology in appeal cases. Psychiatrists and psychologists have complementary skills for the assessment of court referrals. Their evidence and recommendations in appeal cases in Iceland are accepted by the Supreme Court in the great majority (78%) of cases.     

Rethinking criminal responsibility: practical application of operational diagnosis and gnostic into expert testimony]

There had been argument concerning the difference between the agnostic approach and the gnostic approach to the psychiatric perspective of criminal responsibility until the landmark ruling by the 3rd court of the Japanese Supreme Court in 1984. The decision upheld the gnostic approach and affirmed that the defendant's criminal responsibility should be based on such factors as psychopathology, motive, modus operandi, situation surrounding the crime, and pre-morbid personality, as long as the offense was not directly motivated by the delusion or hallucination. The gnostic explanation includes so many various factors that the psychiatric testimony cannot easily be objective, while agnostic experts can find a conclusion about criminal responsibility only by psychiatric diagnosis. To establish a standard, the authors summarized the means of determination of criminal responsibility. The authors also discussed various topics related to criminal responsibility including Asperger's syndrome, illicit drug intoxication, and prescribed drug intoxication.     

限定刑事责任能力的应用

目的：探讨限定刑事责任能力评定量表（DCRRS）在广州地区责任能力3级评定中的应用。方法：采用DCRRS回顾性评定刑事责任能力鉴定504例,进一步检验该量表的信效度及其和专家鉴定结论的一致性。结果：DCRRS的分半信度为0.90,各条目之间及其与总量表分之间的相关均有统计学意义（r=0.11-0.91,P〈0.05）。据DCRRS的参考划界分分组,无、限定和完全责任能力3组间及两两间总量表分的差异均具有统计学意义（P〈0.001）。DCRRS评定和专家鉴定两种责任能力分级方法的结果一致性较好（Kappa值=0.71,P〈0.001）,建立判别函数,回代的判别正确率分别为96.2%和86.7%。结论：DCRRS在广州地区使用的信效度良好,可推广用于责任能力3级评定的辅助参考。     

Quelle est la responsabilité pénale de l’auteur d’une infraction commise sous l’emprise d’un état alcoolique ?

ContextExcessive consumption of alcohol is a major problem for public health in France and in particular in Pays de la Loire and Brittany. It is considered a factor encouraging criminal behaviors. There is a paradox between the alcohol consumption considered by judges as aggravating circumstances of the infraction on one hand and scientific data establishing that in certain circumstances (amount, consumption habits, background, polydrug use, …) alcohol could change the judgment and discernment of the consumer on the other hand. However, during criminal proceedings, the expert psychiatrist may be called upon to assess the degree of discernment of the perpetrator of the committed infraction under the influence of alcohol. Depending on whether the judge pronounce an intact, an altered or an abolished discernment — after having taken into account the conclusions of the expert psychiatrist — the perpetrator of the infraction will be considered as entirely or partially responsible or as irresponsible.GoalThe goal is to assess the proportion of abolition or alteration of discernment that is proposed by psychiatrists when an infraction is committed under the influence of alcohol.Patient and methodologyThe study is retrospective and multicentric. It includes the criminal appraisals relating to the liability that have been performed by psychiatrists of the Courts of Appeal of Rennes and Angers over the period from the 1^st January 2015 to the 31^st December 2016. The exclusion criteria are criminal appraisals which do not relate to criminal liability and criminal investigations for infractions that are not committed under the influence of alcohol.ResultsWe browse 529 psychiatric appraisals and 104 of them were included. Appraisals that did not correspond to evaluation of responsibility (appraisals of victim, appraisals of guardianship or curatorship, appraisals of dangerousness after sentencing), appraisals for which author of the facts did not consume alcohol or data on alcohol consumption was not available, were excluded. Seven experts psychiatrists practicing in Brittany and Pays de la Loire did contribute to the study. The statistical analysis did not brought to light an impact of alcohol consumption on the degree of discernment assessed by the experts. The existence of an alcohol-related disorder in the perpetrator was not significantly associated with an impairment of discernment. On the other hand, the presence of psychiatric comorbidity (p < 0,001) and the existence of a psychiatric care after the commission of the offense (p < 0,02) were the only data significantly associated with an impairment of discernment.ConclusionThe consumption of alcohol during a criminal offense is not retained by the experts as a factor disturbing discernment.     

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   

不同时期精神疾病司法鉴定案例比较

目的探讨我院不同时期所进行的精神疾病司法鉴定案例特点。方法对我院1987年-1996年司法鉴定的292例(A组)与1997年-2003年鉴定的1097例(B组)案例,按鉴定类型、疾病种类、犯罪类型等进行对照分析。结果责任能力、受审能力、申办户口等的例数显著增多,性防卫能力、服刑能力鉴定例数显著减少且评定标准趋严;在责任能力鉴定中,精神正常者、精神发育迟滞(MR)患者的比例显著增多,应激障碍者显著下降;MR和癫痫所致精神障碍的责任能力评定明显趋严。强奸犯罪的亦显著改变。结论应加强对司法精神病学,尤其是责任能力评定的研究,以便更加规范、客观。     

A questionnaire survey on judgment of criminal responsibility]

The authors conducted questionnaire surveys utilizing model cases with the aim of investigating the current views of psychiatrists regarding criminal responsibility judgments in forensic psychiatric evaluations. Six model cases-injury by a person with acute schizophrenia, indecent assault by a person with chronic schizophrenia, attempted murder by a woman with depression, arson by an alcohol abuser, burglary by an amphetamine abuser, rape and indecent assault by a person with personality disorder-were presented to 345 psychiatrists, who were asked about criminal responsibility and appropriate treatment for each of the cases. One hundred eighty-five of the psychiatrists responded. In the case of acute schizophrenia with hallucination and delusion, the case of severe depression, and the personality disorder case, there was a high level of agreement between the evaluations of criminal responsibility made by the different respondents, but in the case of chronic schizophrenia, the case of alcohol-induced psychotic disorder, and the case of amphetamine abuse, there were variations in the evaluation of criminal responsibility, with many respondents emphasizing the patient's symptoms and condition at the time of the offense, and relatively few emphasizing whether the disorder was endogenous. Regarding the form of treatment, many of the respondents recommended compulsory hospitalization for the case of acute schizophrenia with hallucination and delusion, while at the same time recommending treatment in a prison environment for the personality disorder case. In contrast, for the case of chronic schizophrenia and the case of alcohol-induced psychotic disorder, opinion was divided as to whether the subject should be handled with a medical or a judicial approach. Regarding treatment for the case of alcohol-induced psychotic disorder and the case of amphetamine abuse, there was a tendency to make a judgment based on the subject's condition at the point of psychiatric evaluation, which was not necessarily linked to the criminal responsibility.     

Commentary: sex offenders and insanity

Sex offenders with a psychotic illness present challenges in the determination of criminal responsibility, risk assessment, and psychiatric treatment. Novak et al. present data that raise concerns regarding how forensic psychiatrists could conclude sex offenders were not responsible for their offenses in the absence of clear evidence of psychotic symptoms at the time of assessment and/or offense. They also highlight issues of risk assessment and management of psychotic sex offenders that have not been adequately studied. We require further research of psychotic sex offenders to be able to offer scientifically supported opinions on risk assessment to courts and decision-makers.     

Criminal responsibility in sexual homicide perpetrators

OBJECTIVE: Evaluation of criteria for criminal responsibility, esp. in paraphilias and personality disorders. METHODS: We compared sexual murderers with diminished responsibility or not-guilty for reasons of insanity (n = 73) and those held fully responsible (n = 61) regarding psychiatric disorders, signs of severe paraphilias, level of personality structure (using Operationalized Psychodynamic Diagnostics) and offence related criteria. RESULTS: Sexual murderers found as diminished responsible or not-guilty, especially those detained in forensic psychiatric hospitals, showed more signs of a progressive sadistic development and lower levels of personality structure. Offence related criteria that are regarded as not supporting a diminished capacity plea (purposeful actions, long duration, complex, stepwise course of the offence) were found more frequent in those offenders that were detained in forensic hospitals. CONCLUSIONS: Signs for severity of paraphilias and personality disorders are useful in decisions about criminal responsibility. Criteria regarding purposeful course of action appear not to be adequate for the assessment of paraphilic sexual offenders.     

不同作案动机的心理学、医学要件对照研究

目的探讨动机论在司法精神病鉴定中的应用。方法根据田氏动机论的观点,将364例刑事责任能力鉴定案例分组:其中现实动机131例,病理动机113例,混合动机89例,不明动机31例;对不同作案动机的心理学和医学标准进行对照。结果不同作案动机在案型、预谋、诱因、作案对象、作案手段、自我保护、后果意识以及临床特征、责任能力评定等方面均存在显著性差异(P0.001)。结论动机论在司法精神病鉴定实践中具有重要的参考价值。     

Are psychiatrists affecting the legal process by answering legal questions?

BACKGROUND: Psychiatrists are often asked to answer legal questions. The extent to which they answer strictly legal rather than medical matters is not known. AIM: To investigate how strongly psychiatrists in England and Wales express opinions on one legal question - that of diminished responsibility in respect of a murder charge, and how this is related to outcome in court. METHOD Our data were extracted from psychiatric reports and case files supplied by the then Department of Constitutional Affairs (now the Ministry of Justice) on cases heard in the Crown Courts between 1 January 1997 and 31 December 2001 in which the defence of diminished responsibility had been raised. The cases had been selected by the Law Commission in their earlier review of partial defences to murder. We devised a reliable system of rating the presence/absence and strength of expression of a legal opinion in the medical reports. We tested the data for relationship between nature and strength of opinion and progression to trial and verdict. RESULTS Psychiatric reports were available on 143 of 156 cases in which diminished responsibility was considered. They yielded 338 opinions on at least one aspect of diminished responsibility. In 110 (93%) of the 118 cases in which there was a diminished verdict, this was made without trial and, therefore, without reference to a jury. In only eight (27%) out of the 30 cases that went to trial, was a diminished responsibility verdict made. Half of the reports (169) gave a clear opinion on diminished responsibility, a third (121) invited the court to draw a particular conclusion and only 11% (36) provided relevant evidence without answering the legal questions. When there was an opinion or an invitation to make a finding on the legal question, a trial was less likely. A trial was also less likely if reports agreed on what the verdict should be. CONCLUSIONS Psychiatrists frequently answer the legal question of diminished responsibility. The judiciary and medical experts should join in research to examine the consequences of different styles or approaches in presentation of essentially similar evidence in court.     

Reassessing the aftercare treatment of individuals found not guilty due to a mental disability in Hunan, China: supplemental study into the disposition of mentally ill offenders after forensic psychiatric assessment

OBJECTIVE: The purpose of the present paper was to examine the disposition of individuals in Hunan, China who are found not criminally responsible due to a mental disorder or defect. METHOD: Self-developed questionnaires were mailed to the family members of 240 patients who had received forensic psychiatric evaluations at the forensic psychiatric assessment center of Central South University, between 2001 and 2002. RESULTS: One hundred and seventy questionnaires were fully completed and returned by the patients' family members. According to the answers, 64.1% (109 patients) were found not criminally responsible due to a mental disorder or defect. In 87.6% of the cases, a judgement of guilty was in agreement with the psychiatrist's recommendation concerning criminal responsibility. A total of 61.8% of the patients found not guilty were discharged to their families and did not receive any further psychiatric treatment. CONCLUSION: In most cases, judicial decisions are consistent with a psychiatrist's opinion of criminal responsibility due to a mental disorder or defect. After such adjudication, further psychiatric treatment is often neglected due to the lack of resources and information. Hunan, China must make a continued investment into the availability and quality of outpatient mental health treatment for forensic patients after they have been discharged.     

Autonomy, criminal responsibility, and competence

Recently, Juth and Lorentzon proposed to replace the concept of free will, as considered relevant in criminal responsibility, with the concept of autonomy. In addition, they conceived of the assessment of criminal responsibility in terms of a decision-making process. In this article, I suggest that, based on these characterizations, there is an essential similarity between assessments of criminal responsibility and assessments of competent decision-making within the context of informed consent. In both assessments, autonomy and decision-making would be central factors. If one accepts this basic similarity, I argue, interesting opportunities are opened up in the sense that research on criminal responsibility could be directly informed by research on competent decision-making.