抑郁症和躁狂症患者违法行为的犯罪学特征及对照分析

目的探讨抑郁症和躁狂症患者的犯罪学特征,为更好地从事司法精神病学服务提供客观、科学的依据。方法收集近8年以来我室有关情感性精神障碍的司法鉴定资料,对符合纳入标准的73例案例整理、归纳后进行犯罪学特征、刑事责任能力评定的描述性统计和相关性分析,对抑郁症和双相情感障碍躁狂相的违法行为做比较分析。结果情感性精神障碍患者的犯罪学特征:作案前有动机共43例(58.90%),无动机30例(41.10%)(χ2=4.630,P=0.031)。作案前有准备45例(61.60%),没有准备28例(38.40%)(χ2=7.918,P=0.005)。作案后反侦察27例(37.00%),自杀以及其他精神异常表现46例(63.00%)(χ2=9.923,P=0.002)。刑事责任能力评定:有责任能力21例(28.80%),无责任能力18例(24.70%),部分责任能力43例(46.60%)(χ2=6.154,P=0.046)。其中抑郁症患者43例(58.90%),双相情感障碍躁狂相患者30例(41.10%)(χ2=4.630,P=0.031)。抑郁症患者在作案前有准备28例(65.10%),无准备15例(34.90%)(χ2=7.860,P=0.005),作案时间有选择28例(65.10%),没有选择15例(34.90%)(χ2=7.860,P=0.005),作案后有自杀等精神异常表现34例(79.10%),无异常反应9例(20.90%)(χ2=29.070,P=0.000)。双相障碍躁狂相患者在作案有动机20例(66.70%),无动机10例(33.30%)(χ2=6.667,P=0.001),作案时间有选择9例(30.00%),无选择21例(70.00%)(χ2=9.600,P=0.002);双相情感障碍与抑郁症患者在作案时间选择(χ2=8.718,P=0.003)、作案后表现(χ2=11.574,P=0.001)方面存在着显著差异。结论情感性精神障碍患者违法行为常常具有作案有动机、作案前有准备、案发后出现自杀和其他精神异常表现居多的特点。其中抑郁症较躁狂症多见,其作案常常具有事前有准备,作案时间有选择,作案后自杀及其他精神异常表现突出等特点。双相障碍躁狂相患者作案常常具有案发前有作案动机、作案时间选择少等特点。两组对照研究发现,抑郁症患者比躁狂症患者作案前更有准备,作案后更多出现自杀以及其他精神异常表现。     

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     

40例性犯罪司法精神医学鉴定的特点分析

目的探讨性犯罪的特点,为预防、减少性犯罪的发生提供参考。方法对四川正泰精神医学司法鉴定所2009年1月-2012年8月进行性犯罪司法精神医学鉴定40例案例资料进行一般人口学、案件资料、医学诊断情况及刑事责任能力评定等相关数据进行分析。结果本组作案者40例均为男性,作案对象55人次均为女性;作案者以精神发育迟滞居多(45%),其余依次为无精神疾病(27.5%)、精神分裂症(25%)、酒精所致精神障碍(2.5%);年龄14~73岁,平均年龄(34.15±13.04)岁,其中以18~45岁占绝大多数(80%);文化程度低,小学和文盲占绝大多数(70%);职业以农民为主(80%);婚姻以未婚居多(72.5%),其余依次为已婚(20%)、离婚(7.5%);少数案例有精神病家族史(12.5%)。选择的作案对象以青少年和儿童为主(85.5%),其中74.5%是留守儿童;作案地点以郊外居多(57.5%),其次为作案人或作案对象家里;作案时间绝大多数选择在白天(92.5%);大多数是第一次作案(75%),所有案例均为单独作案,没有任何人指使。判定为无刑事责任能力12例(30%),部分刑事责任能力2例(5%),完全刑事责任能力26例(65%)。结论性犯罪是男性精神疾病患者一大危险,要防止和减少精神疾病患者性犯罪,必须加强对精神发育迟滞、精神分裂症等精神疾病患者的治疗和管理工作;加强对留守儿童、留守妇女保护工作。     

酒所致精神障碍的司法精神病学鉴定

目的　探讨不同类型的酒所致的精神障碍患者作案和司法精神病学的鉴定特点。方法　采用对照研究的方法 ,根据被鉴定人的临床特点 ,按国内绝大多数学者的分类意见 ,将 12 2名被鉴定人分为普通醉酒 ( 98例 )、复杂性醉酒 ( 10例 )和酒所致的精神病性障碍 ( 14例 ) 3组。进行对照分析。结果　 3组被鉴定人作案的类型、性质 ,对作案过程的回忆 ,作案的动机 ,责任能力的评定等方面均存在统计学意义上的差异 (P <0 0 5 )。结论　普通醉酒、复杂性醉酒、酒所致精神障碍三者间作案的特征有明显不同。对各种类型的酒中毒者的刑事责任能力评定应坚持从严的原则 ,以防止广大人民群众的生命安全受到威胁 ,减少社会财产损失。对特殊人群应加强教育 ,改变饮酒方式 ,稳定社会治安。     

1369例司法精神病学鉴定案例中有无精神障碍者鉴定前诊疗情况比较

目的探讨司法精神病学鉴定中精神障碍者与无精神障碍者既往诊疗情况的差异,以期提高司法精神病学鉴定中对无精神障碍犯罪嫌疑人的识别和鉴别能力。方法采用自编调查表收集2014年-2017年在某司法鉴定所进行刑事责任能力鉴定的1369例被鉴定人的一般信息和鉴定前诊疗信息,根据鉴定诊断分为精神障碍组(n=964)和无精神障碍组(n=405),对两组人口学资料、精神异常史以及就诊情况进行比较,并对无精神障碍组的既往临床诊断进行分析。结果精神障碍组和无精神障碍组年龄、职业、犯罪类型(人身攻击类、经济侵犯类)、既往精神异常史、就诊史以及就诊的时间与方式比较差异均有统计学意义(P0.05或0.01)。精神障碍组的精神异常史率和就诊率均高于无精神障碍组(87.3%vs.37.8%,χ~2=352.874,P0.01;65.2%vs.44.0%,χ~2=53.459,P0.01);无精神障碍组案发后就诊率高于精神障碍组(33.7%vs.12.1%,χ~2=46.302,P0.01);无精神障碍组中就诊次数较精神障碍组少(u=37714.000,P0.01)。精神分裂症类、癔症/应激相关障碍/神经症类和心境障碍是无精神障碍组最常见的临床诊断。结论与精神障碍者相比,无精神障碍者既往多无精神异常史,临床就诊率低,更倾向于案发后就诊和单次就诊,常被诊断为精神分裂症类、癔症/应激相关障碍/神经症类和心境障碍。     

43例司法精神医学鉴定为精神分裂症的凶杀案例分析

目的探讨司法精神医学鉴定诊断为精神分裂症凶杀作案行为及作案后表现的特点。方法对43例司法精神医学鉴定中被诊断为精神分裂症的凶杀案例资料进行回顾性分析。结果精神分裂症占凶杀案例鉴定为有精神障碍总数的43%；被鉴定人作案先兆、动机、预谋、作案方式、作案后表现均有一定的特点。结论精神病理因素影响精神分裂症作案后的表现，综合分析作案行为及作案后的表现，有助于精神分裂症患者凶杀行为的辨认、控制能力评定。     

盗窃案的司法鉴定分析

目的：比较盗窃案作案者的特点及与精神障碍的关系。方法：对145例盗窃案司法鉴定案例按CCMD－2－R诊断标准分组,对一般情况,作案特点及责任能力等进行分析,结果：各种精神疾病患者及无精神病者在年龄、受教育水平、作案特点及责任能力等方面皆有显著差异。结论：盗窃案司法鉴定中以精神发育迟滞最多见,除精神分裂症外,作案者多具有现实动机,无责任能力者较少。     

245例完全责任能力司法鉴定案例特点分析

目的通过对完全责任能力的精神疾病司法鉴定案例分析,探讨此类案件特点。方法收集我院2006～2008年间245例鉴定为完全责任能力案例资料进行统计分析。结果245例完全责任能力者均为现实动机作案,其中案发前有精神病史者140剜,有精神病专科医院的精神障碍诊断者有104例,51例有精神病专科住院史。最后鉴定结论有精神障碍者144例,鉴定前的临床诊断与鉴定诊断的一致率为46．2％。结论实施危害行为时的辨认和控制能力是责任能力评定的核心。     

2001~2010年精神障碍患者违法行为变化趋势

目的:了解10年间精神障碍患者违法行为的变化趋势。方法:随机选取全国12家安康医院,采用自制违法行为精神障碍患者调查表,对2001年1月至2010年12月期间入院的3 205例违法精神障碍患者的基本信息、诊断结构以及案件性质进行调查,并分析比较10年间的变化趋势。结果:10年期间,精神障碍患者违法行为发生的年龄(F=0.68,P=0.73)、性别(Pearsonχ2=15.9,P=0.07)、婚姻状况(Pearsonχ2=20.67,P=0.30)、疾病诊断结构(P0.05)、案件性质(P0.05)在各年份之间差异均无统计学意义。违法精神障碍患者以男性、青壮年、初中以下文化、农民或无业人员以及精神分裂症(74.7%)为违法主体。结论:2001~2010年精神障碍患者违法行为的变化趋势不明显。     

不同精神鉴定申请者与刑事案件性质及鉴定意见的关系

目的:探讨精神鉴定中不同鉴定申请者与刑事案件性质及鉴定意见的关系。方法:对271例精神鉴定的刑事案件按精神鉴定申请者分为家属申请组(155例,57.2%)、办案机关申请组(95例,35.1%)、本人申请组(21例,7.7%);采用自行设计的调查表,收集被鉴定的犯罪嫌疑人一般情况、案由、诊断和结论,并进行比较和分析。结果:3组被鉴定者既往精神疾病史(χ~2=5.424,P0.05)、诊断为精神疾病的比率(χ~2=14.807,P0.01)、鉴定责任能力的分布(χ~2=9.584,P0.01)差异有统计学意义。肇事案与家属申请的关联明显;放火案、强奸猥亵案与办案机关申请的关联明显;毒品案与本人申请的关联明显(χ~2=30.596,P0.05)。家属申请组与诊断品行障碍、人格障碍的关联明显;办案机关申请组与诊断精神发育迟滞的关联明显;本人申请组与诊断无精神病的关联明显(对应分析χ~2=33.158,P0.05)。回归分析发现男性、无精神病史、有前科、本人申请鉴定者较多鉴定为完全刑事责任能力。结论:精神鉴定中不同鉴定申请者其相关的刑事案件性质及鉴定意见均不同,本人申请者其结论多为无精神疾病及完全刑事责任能力。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Summary of Legislation of 1933 of interest to the Department of Mental Hygiene

Psychiatric Quarterly -