精神病司法鉴定中性自我防卫能力鉴定分析

目的探讨精神病司法鉴定中女性精神障碍患者被性侵害案例的特征。方法对91例女性精神障碍患者被性侵害案例的鉴定资料进行回顾性分析。结果被性侵害的女性精神障碍患者中以精神发育迟滞者居多（68．1％）,其次为精神分裂症（24．2％）;性自我防卫能力削弱者（63．7％）明显多于性自我防卫能力丧失者（34．1％）及性自我防卫能力存在者（2．2％）;无性自我防卫能力者以精神分裂症居多（58．1％）,其次为中度精神发育迟滞（22．6％）、轻度精神发育迟滞（9．7％）。结论女性精神障碍患者性自卫能力丧失或削弱者居多,社会及家庭应加强对女性精神障碍患者的监护与管理。     

女性精神障碍患者被性侵害司法鉴定案例分析

目的：探讨女性精神障碍患者被性侵害案例的特征。方法对273例女性精神障碍患者被性侵害的鉴定资料进行回顾性分析。结果被性侵害的女性精神障碍患者中以精神发育迟滞者居多（68．1％）,其次为精神分裂症（19．4％）;性自我防卫能力削弱者（55．3％）明显多于性自我防卫能力丧失者（26．7％）及性自我防卫能力存在者（18．0）;无性自我防卫能力者以精神分裂症居多（57．5％）,其次为重度精神发育迟滞（21．9％）、中度精神发育迟滞（12．3％）、器质性精神障碍（5．5％）。结论女性精神障碍患者性自卫能力丧失或削弱者居多,社会及家庭应加强对女性精神障碍患者的监护与管理。     

女性精神分裂症和精神发育迟滞患者性防卫能力司法鉴定

目的探讨女性精神分裂症和精神发育迟滞患者性侵害时性防卫能力评定的有关因素。方法对193例女性精神分裂症和精神发育迟滞性侵害患者性防卫能力的司法鉴定资料进行分析。结果精神分裂症、精神发育迟滞分别占女性性侵害鉴定案件的12．2％、82．0％,两者文化程度、婚姻状况、精神病家族史、有无躯体疾病合并症及脑电图状况比较差异有显著性（P〈0．05或0．01）。本组患者性防卫能力鉴定为丧失占88．1％,削弱占7．3％,存在占4．7％;不同性防卫能力患者案件特征、性自我防卫能力量表评分及日常生活能力量表评分比较差异有显著性（P〈0．05或0．01）;精神分裂症及中重度精神发育迟滞患者多无性防卫能力,轻度精神发育迟滞患者中性防卫能力丧失占51．1％,削弱占28．9％,存在占20．0％。结论女性精神分裂症及中重度精神发育迟滞患者多无性防卫能力,轻度精神发育迟滞患者性防卫能力的评定是目前司法鉴定的难点,性侵害时的特点、案件特征、性自我防卫能力量表评分及日常生活能力量表评分是评定女性性防卫能力的因素,对评定女性性防卫能力有重要作用。     

女性精神障碍45例被性侵害案例分析

目的探讨女性精神障碍患者被性侵害案的特点及性自卫能力的评定。方法对45例要求性自我防卫能力评定的女性精神障碍患者的鉴定资料采用自编调查表进行回顾性分析。结果在被性侵害的女性精神障碍患者中精神发育迟滞占66．7％，精神分裂症占31．1％，躁狂症占2．2％，其中性自卫能力丧失占86．7％，性自卫能力削弱占13．3％；案发在被告家或偏僻处各占28．9％，在受害人家占22．2％，出租屋占15．6％，工棚、厕所各占2．2％；被性侵害后怀孕11例（24．4％），未孕34例（75．6％）。结论女性精神障碍患者作为特殊的弱势群体，社会及家庭应对她们进行更多的性防卫能力的教育，尽可能避免或减少性侵害案件的发生。     

司法精神医学鉴定94例性受害案例分析

目的探讨女性精神病患者性受害者的疾病种类、精神状态及性防卫能力等因素，为更好地防范此类案件的发生提供依据。方法采用自制调查表对94例女性精神病患者性受害鉴定案例资料进行分析。结果女性受性侵害司法精神病鉴定案例中以精神发育迟滞患者为多见（69．15％），其次为精神分裂症（14．89％）、癫痫及癫痫所致精神障碍（7．45％）等。59．58％性防卫能力丧失，32．98％性防卫能力削弱，而具有性防卫能力者仅占6．38％。在所有案例中，罪犯多数为受害人所熟悉的人，且多发生在受害人或罪犯家里，犯罪分子常采用食物诱惑或以言语威胁为手段，表明女性精神病患者性受害与其性防卫能力丧失或削弱有关。结论女性精神病患者性防卫能力多丧失或削弱，犯罪分子常以她们作为性侵害目标，为更好的保护这一弱势群体的合法权益，应在司法部门加大打击犯罪力度的同时，社会及其家属还要加强对女性精神病患者的性教育及监护治疗。     

女性精神发育迟滞患者被强奸司法鉴定案例分析

目的探讨女性精神发育迟滞患者被强奸案例特征及性防卫能力等相关因素，为更好地保护女性精神病的合法权益提供依据。方法采用自制统计表对97例女性精神发育迟滞被强奸案例的鉴定资料进行统计分析。结果女性精神发育迟滞被强奸案例的年龄呈明显偏态分布，〈35a者占83．2％，以20a左右年龄段比例最高，随着年龄的增加呈逐渐下降趋势。文化程度低（89．7％、农民（80％），无业人员（12．6％）、有既往疾病史（37．8％）、有阳性家族史（21．2％）为多。结论女性精神发育迟滞患者由于其性防卫能力丧失或减弱，更容易出现性受害，且性受害后不易暴露。     

女性精神病患者性自卫能力司法鉴定资料分析

目的探讨女性精神病患者性自卫能力的影响因素，依法维护女性的合法权益。方法采用自制调查表对被鉴定的72例女性精神病患者被强奸案例进行调查分析。结果被强奸的女性精神病患者中，精神发育迟滞占84．72％，精神分裂症占12．5％，躁狂症占2．78％；性自卫能力丧失占81．94％，性自卫能力削弱13．89％，性自卫能力存在占4．17％。多数发生在受害人或犯罪嫌疑人家中，案发地以乡村居多（80．56％）。结论女性精神病患者被强奸与其性自卫能力丧失或削弱有关，为切实维护女性精神病患者的合法权益，应建立预防机制，加强监护，并长期进行生活能力培训及性防卫能力的培训。     

精神发育迟滞患者性自我防卫能力的多元分析

目的探讨影响精神发育迟滞患者的性自我防卫能力评定的相关因素及社会功能水平对性防卫能力的影响。方法采用1：1的病例对照研究方法,对性侵害案中87例精神发育迟滞患者和同期87例非精神发育迟滞精神障碍患者使用自编法医精神病学鉴定案例登记表收集一般资料,韦氏智力测试量表测定智商,成人智残评定量表和功能大体评定量表进行社会功能的评定。结果除文化、职业、性知识、索要财物与性自我防卫能力密切相关外,成人智残评定量表和功能大体评定量表评分对性自我防卫能力评定也有重要意义。多种因子对有性自我防卫能力、性自我防卫能力削弱和无性自我防卫能力的患者的判别正确率分别为73．1%、66．9%和87．2%,总判别正确率为78．1%。结论精神发育迟滞患者性防卫能力评定受诸多因素的影响,在性自我防卫能力评定时除充分考虑社会学、法学因素外,还要考虑其社会功能的水平。多元判别分析模型为精神发育迟滞患者性防卫能力评定提供了有价值的工具。     

民事案件与刑事案件司法精神医学鉴定

目的探讨新时期司法精神医学鉴定案例中刑事案件与民事案件的特征。方法将100例鉴定资料按案件性质分为刑事案件组与民事案件组，从人口学特征．案发至鉴定时间．案由，鉴定结论，病种分布，鉴定目的等方面进行回顾性对比分析。结果刑案组以男性农民多见，民案组以中年女性农民多见。案发至鉴定时间刑案组较民案组及时。病种分布：刑案组精神分裂症、精神发育迟滞占62％；民案组心因性精神障碍和脑外伤所致精神障碍占65．5％。刑案组以杀人、强奸为主（70．42％）；民案组以交通事故、打架、索赔为主（75．82％）。结论精神分裂症、精神发育迟滞是刑事案件最常见的鉴定对象；民事案件中最常见的是心因性精神障碍。应进一步完善精神损伤程度评定标准，加强法律意识和精神病知识的普与宣传教。     

司法鉴定中对受性侵害的女性精神病患者案件的特点分析

目的探讨女性精神分裂症和精神发育迟滞性侵害案件的特点。方法对32例精神分裂症和54例精神发育迟滞性被害司法鉴定案例，进行一般人口学特征、治疗情况、案例特点及鉴定结论等方面的对比分析。结果精神分裂症组较精神发育迟滞组年龄偏大，文化程度较高，已婚较多，但系统治疗率偏低（9．3％）。并且两组在与案犯关系、案发时间、案发地点、被害人态度方面差异有统计学意义（P〈0．05）。而两组被害人的被奸次数及告发情况则无统计学意义（P〉0．05）。结论女性精神分裂症和精神发育迟滞患者性侵害有明显的不同特点；防止性侵害，前者要侧重于治疗，提高治疗率，后者应以管理教育为主。     

Why women don't report sexual assault to the police: the influence of psychosocial variables and traumatic injury

The purpose of this study was to identify the variables that acutely influence reporting practices in female sexual assault victims presenting to an urban clinic or Emergency Department. We conducted a cross-sectional survey of consecutive female victims during an 18-month study period. Patient demographics, assault characteristics, and injury patterns were recorded in all eligible patients using a standardized classification system. At the completion of the forensic examination, victims were asked to complete a psychosocial questionnaire designed to determine specific reasons why women reported or did not report their sexual assault to police. During the study period, 424 women were eligible to participate in the study; 318 (75%) reported the sexual assault to police. One hundred six (25%) did not file a police report, but consented to a medical-legal examination. Women not reporting sexual assault were typically employed, had a history of recent alcohol or drug use, a known assailant, and prolonged time intervals between the assault and forensic evaluation (p < 0.001). There were no differences in the extent of non-genital injuries or anogenital injuries between the two groups. Thirty-six percent (152/424) of the eligible population agreed to complete the questionnaire. Only three of the 20 psychosocial variables examined were found to be significantly different in women not reporting sexual assault compared to reporters. The reasons for not reporting were primarily environmental factors (prior relationship with assailant) rather than internal psychological barriers (shame, anxiety, fear).     

Male sexual assault

Reported cases of sexual assault in the United States increased 21% from 1974 to 1978. Recent literature discusses the medical, legal, and psychological management of the female sexual assault victim, but little has been written regarding appropriate management of male sexual assault. Twenty-nine male sexual assault victims were examined at University Hospital from 1976 to 1980. This study reviews evidence of genital and extragenital trauma and the percentage of those requiring gonorrhea prophylaxis. It further studies the background and characteristics of the sexual assault victim, characterization of the assailant, as well as the details and time of the assault. Information concerning male sexual assault and the unique problems associated with this group is scarce. This study is intended to aid in the development of an effective protocol in dealing with this group of patients and to sensitize physicians to this group of patients.     

Predictors of Genitorectal Injury in Female Victims of Suspected Sexual Assault

OBJECTIVE: Legal decisions in sexual assault cases often hinge on the presence or absence of genitorectal injury. Unfortunately, the forensic literature does not explain why some victims sustain genitorectal injury and others do not. This study explores possible predictors of genitorectal injury in adult female sexual assault victims. METHODS: This retrospective cross-sectional analysis forms the derivation set for a larger planned prospective analysis. The authors extracted data describing consecutive female sexual assault victims who met inclusion criteria between July 1995 and July 1998. Exclusion criteria included male sex, lack of estrogen in females, consensual intercourse within the previous 72 hours, and lack of penetration during the assault. The authors explored associations between genitorectal injury and seven demographic variables, nine assault characteristics, and the time between assault and exam or postcoital interval (PCI). Variables thought to be predictive were incorporated into a logistic regression model. RESULTS: Five hundred forty-eight sexual assault victims were seen during the study time period; 209 of these met the inclusion criteria. Logistic regression controlling for important covariates showed an increase risk of genitorectal injury with a PCI < 24 hours (OR 7.47, 95% CI = 1.78 to 31.35), physical/verbal resistance (OR 5.96, 95% CI = 1.21 to 29.36), rectal penetration (OR 7.47, 95% CI = 1.05 to 53.07), and greater than high school education (OR 7.13, 95% CI = 1.03 to 49.65). CONCLUSIONS: This study presents an important first look at variables that may predict genitorectal injury in sexual assault victims. Future studies that examine more data are needed to corroborate this preliminary derivation set analysis.