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| 8. |
- Dåderman, Anna Maria, 1953-, et al.
(författare)
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Degree of psychopathy : implications for treatment in male juvenile delinquents
- 2003
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Ingår i: International Journal of Law and Psychiatry. - Oxford : Pergamon Press. - 0160-2527 .- 1873-6386. ; 26:3, s. 301-315
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Tidskriftsartikel (refereegranskat)abstract
- Longitudinal studies have consistently shown that psychopathy in adulthood has its roots in childhood. The psychopathy concept described by Cleckley (1976) involves interpersonal, affective, and behavioral aspects. Moreover, children who show low levels of anxiety respond more poorly to treatment. The aim of the present study was to assess psychopathy in 56 male juvenile delinquents with conduct disorder, treated in youth correctional institutions for severe offenders. We used a modified Psychopathy Checklist-Revised (PCL-R) that has been used for young people (Forth et al., 1990). Each participant received PCL-R assessments from one rater, based on the file information and an extensive interview. Twenty-eight participants (50%) were rated by the second rater. Both the ICC and Cohens’s kappa revealed that the PCL-R ratings were reliable: the ICC(2,1) of the PCL-R total scores was 0.90, F(27, 28) = 11.70, P < .0001; Cohen’s kappa = 0.64, P < .001. The final scores on the PCL-R showed that the base rate for psychopathy (defined as a score of 30 or more) in the sample was 59% (33 of 56 juvenile delinquents). The mean PCL-R total score for all 56 participants was 29.3 (S.D. = 7.8), and ranged between 12 and 40. The high rates of psychopathy found in juvenile delinquents with conduct disorder should alert clinicians to the necessity of psychopathy scoring, and shows that high-quality treatment programs are needed. Psychopathy is not currently considered when assessing and treating young people in state-administered observational and correctional institutions for juvenile delinquents in Sweden.
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| 11. |
- af Klinteberg, Britt, et al.
(författare)
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Projective risk variables in early adolescence and subsequent disinhibitory psychopathology
- 2008
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier BV. - 0160-2527 .- 1873-6386. ; 31:3, s. 210-218
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Tidskriftsartikel (refereegranskat)abstract
- The objective was to examine early adolescent projective risk indicators for the development of antisocial behaviour as related to adult personality traits, psychopathy, and violent behaviour over the life span. Assessment data included Rorschach (Rr) ratings (at age 11-14 years), personality inventories (EPQ-I and KSP scales), and a shortened Psychopathy Check List (PCL) (administered at age 32-40 years), obtained from a group of 199 male subjects; and smoking habits (at age 36-44 years) obtained from 125 of those subjects. Results, controlled for intelligence, indicated that the high and very high risk groups, as determined by level of total Rr risk scores, were (1) significantly higher on self-rated IVE Impulsiveness, the anxiety-related KSP Muscular Tension, and nonconformity traits, as compared to the low Rr risk group - the very high risk group also scoring significantly higher on the EPQ Psychoticism scale, related to aggressiveness and cruelty; (2) higher on clinically rated PCL total sum and factor scores; and (3) they were overrepresented among Ss with subsequent violent offence, and Ss with heavy smoking habits. The results are discussed in terms of the possible usefulness of psychodynamic oriented cognitive-emotional indicators in the search for underlying mechanisms in the development of disinhibitory psychopathology.
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| 13. |
- Alexiou, Eirini, et al.
(författare)
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Criminal recidivism of patients in Swedish forensic psychiatry: A register-based comparison study
- 2023
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier BV. - 0160-2527. ; 88
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of this study was to evaluate criminal outcomes of mentally disordered offenders in compulsory forensic psychiatric care during the year 2010 versus 2018. More specifically, we sought to identify the occurrence of new criminal sentences during ongoing treatment and possible factors associated with recidivistic criminality. Another aim was to map previous criminality, types of index crime, and whether there were any changes within this decade.Methods: Crime-, clinical, and treatment-related variables were collected from the Swedish National Forensic Psychiatric Register for all unique inpatients registered from January 1-December 31 in 2010 (N = 717) and 2018 (N = 757). The mean, frequency, percentage, and standard deviation were calculated per variable and stratified by study year and gender. Between-group comparisons were made using t-tests and Chi-square tests. Binary logistic regression was performed to determine whether variables expected to be associated with recidivism showed any relation to criminal recidivism for each study cohort.Results: Most patients were male and approximately one-quarter and one-half of the men, respectively, had a previous sentence for non-violent and violent crimes. The 2018 cohort showed significantly lower rates of sentences to forensic psychiatry with special court supervision although the numbers were low in both cohorts and for both men and women. Previous violent conviction was associated with criminal recidivism during treatment in 2010, while this was joined by index crime under the influence of alcohol/illicit drugs for the 2018 cohort.Conclusions: Overall, these results showed more similarities between the 2010 and 2018 cohorts then dissimilarities, while on the other hand some quite substantial differences were described between males versus females. The results of this study indicate that it may be possible to tailor forensic psychiatric treatment to gender as a proxy for other variables related to increased criminal recidivism in offenders sentenced to forensic psychiatric care.
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| 14. |
- Allely, Clare Sarah, et al.
(författare)
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A legal analysis of Australian criminal cases involving defendants with autism spectrum disorder charged with online sexual offending
- 2019
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier BV. - 0160-2527. ; 66
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Tidskriftsartikel (refereegranskat)abstract
- This paper examines how the symptomology of the small number of individuals with autism spectrum disorder (ASD) charged with online sexual offenses in Australia is established during legal arguments and conceived by the judiciary to impact legal liability and offending behavior. This study aims to provide empirical support for the proposition that judicial discourses regarding the connection between ASD and online sexual offending, including conduct related to child exploitation material (CEM), have little bearing on overall questions of criminal liability or the use of alternative penal dispositions. It does so by exploring a sample of nine recent Australian criminal cases, involving ten rulings, that examine how evidence of ASD is raised in legal arguments in ways that suggest a diagnosed condition may have contributed significantly to the alleged wrongdoing. We conclude by suggesting current Australian judicial practice requires more sensitivity to the impact of clinical factors associated with ASD in shaping alternative supervisory and non-custodial dispositions for individuals convicted of online sexual offenses. © 2019 Elsevier Ltd
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| 15. |
- Anckarsäter, Henrik, 1966
(författare)
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Beyond categorical diagnostics in psychiatry: Scientific and medicolegal implications.
- 2010
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Ingår i: International journal of law and psychiatry. - : Elsevier BV. - 1873-6386 .- 0160-2527. ; 33:2, s. 59-65
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Tidskriftsartikel (refereegranskat)abstract
- Conforming to a medical disease model rooted in phenomenology and natural science, psychiatry classifies mental disorders according to signs and symptoms considered to be stable and homogeneous across individuals. Scientific studies addressing the validity of this classification are scarce. Following a seminal paper by Robins and Guze in 1970, validity of categories has been sought in specific criteria referring to symptoms and prognosis, aggregation in families, and "markers", preferentially laboratory tests. There is, however, a growing misfit between the model and empirical findings from studies putting it to the test. Diagnostic categories have not been shown to represent natural groups delineated from the normal variation or from each other. Aetiological factors (genetic and/or environmental), laboratory aberrations, and treatment effects do not respect categorical boundaries. A more adequate description of mental problems may be achieved by: 1) a clear definition of the epistemological frame in which psychiatry operates, 2) a basic rating of the severity of intra- and interpersonal dysfunctions, and 3) empirical comparisons to complementary rather than exclusive dimensions of inter-individual differences in context-specific mental functions, treatment effects, and laboratory findings. Such a pluralistic understanding of mental health problems would fit empirical models in the neurosciences and postmodern notions of subjectivity alike. It would also clarify the assessment of dysfunction and background factors in relation to the requisites for penal law exemptions or insurance policies and make them empirically testable rather than dependent on expert opinion on issues such as whether a specific dysfunction is "psychiatric", "medical", or ascribable to "personality".
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| 16. |
- Anckarsäter, Henrik, 1966, et al.
(författare)
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Mental disorder is a cause of crime: The cornerstone of forensic psychiatry
- 2009
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier BV. - 0160-2527 .- 1873-6386. ; 32:6, s. 342-347
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Tidskriftsartikel (refereegranskat)abstract
- The assumption that mental disorder is a cause of crime is the foundation of forensic psychiatry, but conceptual. epistemological. and empirical analyses show that neither mental nor crime, or the causation implied, are clear-cut concepts. "Mental" denotes heterogeneous aspects of a per-son such as inner experiences. cognitive abilities, and behaviour patterns described in a non-physical vocabulary. In psychology and psychiatry, mental describes law-bound, caused aspects of human functioning that are predictable and generalizable. Problems defined as mental disorders are end-points of dimensional inter-individual differences rather than natural categories. Deficits in cognitive faculties, such as attention, verbal understanding, impulse control, and reality assessment, may be susceptibility factors that relate to behaviours (Such as crimes) by increasing the probability (risk) for a negative behaviour or constitute causes in the sense of INUS conditions (insufficient but Non-redundant parts of Unnecessary but Sufficient conditions). Attributing causes to complex behaviours such as crimes is not an unbiased process, and mental disorders will attract disproportionate attention when it comes to explanations of behaviours that we wish to distance ourselves from. Only by rigorous interpretation of what psychiatry actually can inform us about, using empirical analyses of quantified aggressive antisocial behaviours and their possible explanatory factors, can we gain a clearer notion of the relationship between mental disorder and crime. (C) 2009 Elsevier Ltd. All rights reserved.
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| 17. |
- Andershed, Henrik, et al.
(författare)
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Does the three-factor model of psychopathy identify a problematic subgroup of young offenders?
- 2008
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier BV. - 0160-2527 .- 1873-6386. ; 31:3, s. 189-198
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Tidskriftsartikel (refereegranskat)abstract
- The present study tests the utility of the personality-based three-factor model of psychopathy according to the Hare Psychopathy Checklist: Screening Version (PCL:SV). This model of psychopathy excludes aspects of criminal behavior as opposed to other models of psychopathy. The main research question was to what extent the three-factor model of psychopathy can identify a problematic subgroup of young offenders. The sample consisted of 148 incarcerated young male criminal offenders, between 15 and 25 years of age (mean=19.07, SD=2.11) who were recruited from a central detention center for young offenders in a northern German county. Model-based cluster analysis of the three psychopathy factors showed that three different clusters labeled: (i) Unemotional/Impulsive-Irresponsible, (ii) Low traits, and (iii) Psychopathic personality, had the best fit to the data. The psychopathic personality cluster with high scores on all three factors of the PCL:SV exhibited, as expected, a significantly higher prevalence of conduct disorder and substance use problems, but was not significantly different from the other clusters on past criminality and previous incarcerations. In conclusion, the results showed that the three-factor model of psychopathy can be useful in identifying a problematic subgroup of young offenders. (C) 2008 Published by Elsevier Inc.
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| 18. |
- Andreasson, Helena, et al.
(författare)
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Predictors of length of stay in forensic psychiatry: The influence of perceived risk of violence
- 2014
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier BV. - 0160-2527. ; 37:6, s. 635-642
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Tidskriftsartikel (refereegranskat)abstract
- This study describes the prevalence of adverse events and length of stay in forensic psychiatric patients with and without a restriction order. Detailed clinical and administrative information from medical records and written court decisions was gathered retrospectively from admission until discharge for a Swedish population-based, consecutive cohort of forensic psychiatric patients (n = 125). The median length of stay for the whole cohort was 951 days, but patients with a restriction order stayed in hospital almost five times as long as patients without. Restriction orders were related to convictions for violent crime, but not for any other differences in demographic or clinical variables. The majority of the patients (60%) were involved in adverse events (violence, threats, substance abuse, or absconding) at some time during their treatment. Patients with restriction orders were overrepresented in violent and threat events. Previous contact with child and adolescence psychiatric services, current violent index crime, psychotic disorders, a history of substance, and absconding during treatment predicted longer length of stay. Being a parent, high current Global Assessment of Functioning scores, and mood disorders were all significantly related to earlier discharge. In a stepwise Cox regression analysis current violent index crime and absconding remained risk factors for a longer hospital stay, while a diagnosis of mood disorder was significantly related to a shorter length of stay.
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| 19. |
- Bergenheim, Åsa, 1954-
(författare)
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Sexual assault, irresistible impulses, and forensic psychiatry in Sweden
- 2014
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier. - 0160-2527 .- 1873-6386. ; 37:1, s. 99-108
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Tidskriftsartikel (refereegranskat)abstract
- After forensic psychiatry was firmly established in Sweden in the 1930s, many rapists and individuals charged with assaulting children underwent a forensic psychiatric examination. The physicians found that most of them had not been “in control” of their senses or not “in complete control” of their senses at the time of the crime. If the court ordered a forensic psychiatric examination, the defendant had a very good chance of either being discharged or having his sentence reduced considerably. By the 1950s psychological perspectives began to dominate in forensic psychiatry. In the forensic records of the 1950s we can notice a shift from a biomedical to a socio-psychological perspective, and crime was increasingly related to conditions that were not seen as mental derangement from a legal point of view. As a result, it became less and less common, from the 1950s onwards, for sentences to be commuted or defendants discharged.
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| 20. |
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| 21. |
- Creaby-Attwood, A., et al.
(författare)
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A psycho-legal perspective on sexual offending in individuals with autism Spectrum disorder
- 2017
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier BV. - 0160-2527. ; 55, s. 72-80
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Tidskriftsartikel (refereegranskat)abstract
- It is important to consider whether there are innate vulnerabilities that increase the risk of an individual with an autistic spectrum disorder (ASD), predominantly those defendants with a diagnosis of Asperger's Syndrome, being charged and convicted of a sexual offence. The significance of such can be readily seen in recent English case law, with judgments on appeal finding convictions unsafe where there have been a number of failings in the Judge's summing up. In this article, we will consider the gravity of Judges omitting to highlight a defendant's diagnosis of autism spectrum disorder and the necessity of detailed explanations to jury members regarding the condition and its effect upon thoughts and behaviour. Consideration will be specifically given to the necessity to prove sexual motivation in such offences and the judicial direction required in relation to whether the appellant's actions had been sexually motivated. Recognition of the social impairments inherent in ASDs are vital to this work and we shall consider whether the difficulty with the capacity to develop appropriate, consenting sexual relationships as a result of impaired social cognition may be one of the factors which increases the risk of sexual offending in individuals with ASD (Higgs & Carter, 2015). (C) 2017 Elsevier Ltd. All rights reserved.
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| 22. |
- Dahlin, Moa Kindstrom, et al.
(författare)
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Mentally disordered criminal offenders : Legal and criminological perspectives
- 2009
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier BV. - 0160-2527 .- 1873-6386. ; 32:6, s. 377-382
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Tidskriftsartikel (refereegranskat)abstract
- Legal research in Sweden has traditionally focused on a systematization of the legal rules and their practical application, while the task of studying the effects of the application of the laws has been handed over to other branches of the social sciences. In contrast, new legal theories focusing on proactive and therapeutic dimensions in law have gained increasing attention in the international arena. These approaches may be better suited for evaluating legislation governing compulsory psychiatric care. Theoretical discussions and studies of causal mechanisms underlying criminal behaviour, as well as the implementation and value of instruments for predicting behaviour, are relevant to contemporary criminological research. Criminal behaviour varies across different groups of perpetrators, and the causes can be sought in the interplay between the individual and social factors. Multi-disciplinary efforts, integrating research from forensic psychiatry, psychology, sociology, and criminology, would be beneficial in leading to a better understanding of the causes underlying criminal behaviour.
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| 23. |
- Degl'Innocenti, Alessio, 1961, et al.
(författare)
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First report from the Swedish National Forensic Psychiatric Register (SNFPR)
- 2014
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier BV. - 0160-2527. ; 37:3, s. 231-237
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Tidskriftsartikel (refereegranskat)abstract
- To the best of our knowledge, the present register is the only nationwide forensic psychiatric patient register in the world. The aim of this article is to describe the content of the Swedish National Forensic Psychiatric Register (SNFPR) for Swedish forensic patients for the year 2010. The subjects are individuals who, in connection with prosecution due to criminal acts, have been sentenced to compulsory forensic psychiatric treatment in Sweden. The results show that in 2010, 1476 Swedish forensic patients were assessed in the SNFPR; 1251 (85%) were males and 225 (15%) were females. Almost 60% of the patients had a diagnosis of schizophrenia, with a significantly higher frequency among males than females. As many as 70% of the patients had a previous history of outpatient psychiatric treatment before becoming a forensic psychiatric patient, with a mean age at first contact with psychiatric care of about 20 years old for both sexes. More than 63% of the patients had a history of addiction, with a higher proportion of males than females. Furthermore, as many as 38% of all patients committed crimes while under the influence of alcohol and/or illicit drugs. This was more often the case for men than for women. Both male and female patients were primarily sentenced for crimes related to life and death (e.g., murder, assault). However, there were more females than males in treatment for general dangerous crimes (e.g., arson), whereas men were more often prosecuted for crimes related to sex. In 2010, as many as 70% of all forensic patients in Sweden had a prior sentence for a criminal act, and males were prosecuted significantly more often than females. The most commonly prescribed pharmaceuticals for both genders were antipsychotics, although more women than men were prescribed other pharmaceuticals, such as antidepressants, antiepileptics, and anxiolytics. The result from the present study might give clinicians an opportunity to reflect upon and challenge their traditional treatment methods. (C) 2013 Elsevier Ltd. All rights reserved.
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| 24. |
- Diesen, Christian, et al.
(författare)
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Sex crime legislation : Proactive and anti-therapeutic effects
- 2010
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier BV. - 0160-2527 .- 1873-6386. ; 33:06-maj, s. 329-335
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Tidskriftsartikel (refereegranskat)abstract
- Therapeutic jurisprudence may have its major role within law practice, but analysis of the law from a therapeutic perspective is a task that should not be neglected: how a piece of legislation is designed and formulated certainly influences the therapeutic outcome of a legal process. This article uses sex legislation as an example to demonstrate how the old rape law based on coercion has anti-therapeutic effects on rape victims. If the law requires resistance, it implies that a woman is sexually available until she resists physically, resulting in an attitude that a woman reporting rape without injuries should be mistrusted. This mistrust of the victim and the victim's attendant feelings of self-blame aggravate the victim's trauma. On the other hand, a modern rape law based on lack of consent gives the signal that a woman is not available until she has given her consent, resulting in a different starting position for the investigation. Since the will of the victim must be respected, the victim herself must be respected in the legal process. Furthermore, being able to tell one's story in a respectful atmosphere can be more important for the well-being of the victim than the outcome of the reported case.
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| 25. |
- Dåderman, Anna Maria, 1953-, et al.
(författare)
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Psychopathy-related personality traits in male juvenile delinquents : an application of a person-oriented approach
- 2004
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Ingår i: International Journal of Law and Psychiatry. - Göttingen : Elsevier. - 0160-2527 .- 1873-6386. ; 27:1, s. 45-64
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Tidskriftsartikel (refereegranskat)abstract
- Some personality characteristics, such as impulsiveness, thrill seeking, and the need for change, are clearly relevant when studying psychopathy. Psychopaths are certainly avid sensation seekers. The primary aim of the present study was to identify common patterns with respect to psychopathy-related personality traits in a sample of 56 juveniles from four Swedish national correctional institutions for juvenile delinquents. Karolinska Scales of Personality (KSP), the Impulsiveness scale from the Impulsiveness–Venturesomeness–Empathy (IVE) inventory and the Total Sensation-Seeking scale from the SSS-V were used to determine personality traits. Cluster analysis was performed with SLEIPNER. Ward’s hierarchical minimum variance clustering method was used. We discovered seven clusters of participants. The mean T scores of the profiles of personality traits in the clusters (the cluster centroids) have been used to describe the clusters. Three multideviant clusters emerged, into which 31 (63%) of the classified participants could be placed. To describe the clusters, the prevalence of participants with a high degree of psychopathy (cutoff PCL-R score 27or above) was computed for each cluster and was complemented with data on previous treatment occasions and reoffending. The results indicated that psychopaths may develop different personality pattern; each cluster contained participants with high values of the PCL-R. Deviant personality is not currently considered when assessing and treating people in state administered observational and correctional institutions for juvenile delinquents in Sweden. The present results suggest that young people with psychopathy are not a homogenous group but may develop various personality traits. This should have implications for risk assessment and treatment.
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| 26. |
- Grann, Martin, et al.
(författare)
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Methodological development : structured outcome assessment and community risk monitoring (SORM)
- 2005
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier BV. - 0160-2527 .- 1873-6386. ; 28:4, s. 442-456
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Tidskriftsartikel (refereegranskat)abstract
- This paper describes an effort to develop a clinical tool for the continuous monitoring of risk for violence in forensic mental health clients who have left their institutions and who are dwelling in the community on a conditional release basis. The model is called Structured Outcome Assessment and Community Risk Monitoring (SORM). The SORM consists of 30 dynamic factors and each factor in SORM is assessed in two ways: The current absence, presence or partial och intermittent presence of the factors, which is an actuarial (systematized and 'objective') assessment. Secondly, the risk effect, i.e. whether the presence/absence of factors currently increases, decreases or is perceived as unrelated to violence risk, is a clinical (or impressionistic) assessment. Thus, the factors considered via the SORM can be coded as risk factors or protective factors (or as factors unimportant to risk of violence) depending on circumstances that apply in the individual case. Further, the SORM has a built-in module for gathering idiographical information about risk-affecting contextual factors. The use of the SORM and its potential as a risk monitoring instrument is illustrated via preliminary data and case vignettes from an ongoing multicenter project. In this research project, patients leaving any of the 9 participating forensic hospitals in Sweden is assessed at release on a variety of static background factors, and the SORM is then administered every 30 days for 2 years.
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| 27. |
- Grazier, Kyle L, et al.
(författare)
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Rationing psychosocial treatments in the United States
- 2005
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier. - 0160-2527 .- 1873-6386. ; 28:5, s. 545-560
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Tidskriftsartikel (refereegranskat)abstract
- This paper briefly reviews the recent history of psychosocial treatment for adults with severe mental illnesses in the United States. It examines the current sources and financing of such care, revealing the planned and unplanned reclassification of entitled beneficiaries and eligible patients, appropriate treatment, acceptable outcomes, and levels and sources of payment. One illustration of this phenomenon is seen in current efforts to identify and deliver only those public services that are covered by Medicaid, so as to allocate state resources only when they can be matched by federal monies. Another is the reliance on private health insurance, tied in the U.S. almost exclusively to employment, for medical care delivered under an acute, rather than a chronic care model. These analyses conclude with a discussion of the implicit and explicit mechanisms used to ration access to psychosocial treatment in the United States. The implications for individuals with serious mental illnesses, their families, and the general public are placed in historical and current policy contexts, recognizing the economic, social, and clinical variables that can moderate outcomes.
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| 28. |
- Gröning, L., et al.
(författare)
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Remodelling criminal insanity: Exploring philosophical, legal, and medical premises of the medical model used in Norwegian law
- 2022
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier BV. - 0160-2527. ; 81
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Tidskriftsartikel (refereegranskat)abstract
- This paper clarifies the conceptual space of discussion of legal insanity by considering the virtues of the ‘medical model’ model that has been used in Norway for almost a century. The medical model identifies insanity exclusively with mental disorder, and especially with psychosis, without any requirement that the disorder causally influenced the commission of the crime. We explore the medical model from a transdisciplinary perspective and show how it can be utilised to systematise and reconsider the central philosophical, legal and medical premises involved in the insanity debate. A key concern is how recent transdiagnostic and dimensional approaches to psychosis can illuminate the law's understanding of insanity and its relation to mental disorder. The authors eventually raise the question whether the medical model can be reconstructed into a unified insanity model that is valid across the related disciplinary perspectives, and that moves beyond current insanity models. © 2022 The Authors
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| 29. |
- Görtz, Daniel, et al.
(författare)
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The stage-value model: Implications for the changing standards of care.
- 2015
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier BV. - 0160-2527. ; 42-43, s. 135-143
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Tidskriftsartikel (refereegranskat)abstract
- The standard of care is a legal and professional notion against which doctors and other medical personnel are held liable. The standard of care changes as new scientific findings and technological innovations within medicine, pharmacology, nursing and public health are developed and adopted. This study consists of four parts. Part 1 describes the problem and gives concrete examples of its occurrence. The second part discusses the application of the Model of Hierarchical Complexity on the field, giving examples of how standards of care are understood at different behavioral developmental stage. It presents the solution to the problem of standards of care at a Paradigmatic Stage 14. The solution at this stage is a deliberative, communicative process based around why certain norms should or should not apply in each specific case, by the use of "meta-norms". Part 3 proposes a Cross-Paradigmatic Stage 15 view of how the problem of changing standards of care can be solved. The proposed solution is to found the legal procedure in each case on well-established behavioral laws. We maintain that such a behavioristic, scientifically based justice would be much more proficient at effecting restorative legal interventions that create desired behaviors.
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| 30. |
- Hofvander, Björn, et al.
(författare)
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Continuity of aggressive antisocial behavior from childhood to adulthood: The question of phenotype definition.
- 2009
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier BV. - 0160-2527. ; 32:4, s. 224-234
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Tidskriftsartikel (refereegranskat)abstract
- Aiming to clarify the adult phenotype of antisocial personality disorder (ASPD), the empirical literature on its childhood background among the disruptive behaviour disorders, such as attention deficit/hyperactivity disorder (AD/HD), oppositional defiant disorder (ODD), conduct disorder (CD), or hyperkinetic conduct disorder (HKCD), was reviewed according to the Robins and Guze criteria for nosological validity. At least half of hyperactive children develop ODD and about a third CD (i.e. AD/HD+CD or HKCD) before puberty. About half of children with this combined problem constellation develop antisocial personality disorder (ASPD) in adulthood. Family and adoption/twin studies indicate that AD/HD and CD share a high heritability and that, in addition, there may be specific environmental effects for criminal behaviours. "Zones of rarity" delineating the disorders from each other, or from the normal variation, have not been identified. Neurophysiology, brain imaging, neurochemistry, neurocognition, or molecular genetics have not provided "external validity" for any of the diagnostic categories used today. Deficient mental functions, such as inattention, poor executive functions, poor verbal learning, and impaired social interaction (empathy), seem to form unspecific susceptibility factors. As none of today's proposed syndromes (e.g. AD/HD or psychopathy) seems to describe a natural category, a dimensional behavioural phenotype reflecting aggressive antisocial behaviours assessed by numbers of behaviours, the severity of their consequences and how early is their age at onset, which will be closely related to childhood hyperactivity, would bring conceptual clarity, and may form the basis for further probing into mental, cognitive, biological and treatment-related co-varying features.
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| 31. |
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| 32. |
- Höglund, Pontus, et al.
(författare)
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Accountability and psychiatric disorders: How do forensic psychiatric professionals think?
- 2009
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Ingår i: International journal of law and psychiatry. - : Elsevier BV. - 0160-2527 .- 1873-6386. ; 32:6, s. 355-361
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Tidskriftsartikel (refereegranskat)abstract
- Swedish penal law does not exculpate on the grounds of diminished accountability; persons judged to suffer from severe mental disorder are sentenced to forensic psychiatric care instead of prison. Re-introduction of accountability as a condition for legal responsibility has been advocated, not least by forensic psychiatric professionals. To investigate how professionals in forensic psychiatry would assess degree of accountability based on psychiatric diagnoses and case vignettes, 30 psychiatrists, 30 psychologists, 45 nurses, and 45 ward attendants from five forensic psychiatric clinics were interviewed. They were asked (i) to judge to which degree (on a dimensional scale from 1 to 5) each of 12 psychiatric diagnoses might affect accountability, (ii) to assess accountability from five case vignettes, and (iii) to list further factors they regarded as relevant for their assessment of accountability. All informants accepted to provide a dimensional assessment of accountability on this basis and consistently found most types of mental disorders to reduce accountability, especially psychotic disorders and dementia. Other factors thought to be relevant were substance abuse, social network, personality traits, social stress, and level of education.
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| 33. |
- Innocenti, Alessio, et al.
(författare)
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A register-based comparison study of Swedish patients in forensic psychiatric care 2010 and 2018
- 2021
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier BV. - 0160-2527. ; 77
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: This study compared the characteristics of a population of Swedish patients in forensic psychiatric care in the year 2010 and 2018, with the goal of identifying similarities and differences in sociodemographic and clinical outcomes during the study period. Findings: Significant changes in patient characteristics and treatment aspects were found, although similarities between the years were more common. Schizophrenia, schizotypal and delusional disorders were the most predominant primary diagnoses characterizing forensic psychiatric patients. From 2010 to 2018 there was also a development in care conditions supporting a shift from inpatient to outpatient care and from first-generation antipsychotic/neuroleptic to second-generation antipsychotics/atypical antipsychotics. More liberty restrictive such as physical restraints and forcible medication diminished while less restrictive coercive measures increased. There was also a decrease in the length of stay in forensic psychiatric care among those treated 2018 compared to those treated 2010, something that emerged as particularly discernible among male patients. Conclusion: In conclusion, the results from this study illustrate the similarities among a Swedish forensic psychiatric population between the years of 2010 and 2018, while also reflecting some changes in patient characteristics and clinical practice during the study period.
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| 34. |
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| 35. |
- Khoshnood, Ardavan, et al.
(författare)
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Deadly violence in Sweden: Profiling offenders through a latent class analysis
- 2020
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier BV. - 0160-2527. ; 71:July-August
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundSweden has in recent years witnessed increasing rates of firearm-related violence and homicide, which has contributed to increased rates of deadly violence. Attempts to profile offenders committing such crimes are of major importance, because such efforts may contribute to better preventive measures. We therefore aimed to study the characteristics of individuals convicted and/or suspected of homicide, attempted homicide, preparation to commit homicide as well as conspiration to commit homicide (for simplicity called homicide+) in Sweden.MethodsBy using information from the Swedish Crime Register and the Swedish Criminal Suspect Register, individuals being 15–60 years old and convicted and/or suspected of homicide+ between 2000 and 2015 were included in the study. Using these registers and also other population and health care registers, information on previous criminality, substance abuse, and psychiatric disorders were added to the Latent Class Analysis (LCA) that was used to identify latent classes of individuals convicted and/or suspected for homicide+. In addition, several individual variables were added for validation purposes.ResultsA total of 14,466 individuals were included in the analysis. The majority were male (n = 12,802; 88.5%) and Swedish-born with Swedish-born parents (n = 8247; 57.0%). The LCA identified three classes where Conviction Class (CC) contained mostly convicted individuals whereas Mixed Class A (MCA) and Mixed Class B (MCB) contained almost equal rates of both convicted and suspected individuals. The CC was characterized by individuals with low rates of previous criminality, substance abuse and psychiatric disorders. The MCA and the MCB were characterized by individuals with higher rates of previous criminality, substance abuse, and psychiatric disorders as well as lower education and worse economy in comparison with the CC.ConclusionWhile MCA and MCB may be constituted by “traditional” criminals often well known by the police and/or the social authorities, the CC was mainly constituted by convicted offenders who may more easily escape the radar of the authorities.
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| 36. |
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| 37. |
- Kindström Dahlin, Moa, et al.
(författare)
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Swedish Legal Scholarship Concerning Protection of Vulnerable Groups : Therapeutic and Proactive Dimensions
- 2010
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier BV. - 0160-2527 .- 1873-6386. ; 33:5-6, s. 398-405
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Tidskriftsartikel (refereegranskat)abstract
- This paper presents a brief overview of the legal theoretical problems that arise in connection with the societal ambition of protecting vulnerable groups. One of the central difficulties in legislation with proactive and therapeutic ambitions arises from the link between law and philosophy of science, i.e., the relationship between facts and norms. It is shown that Therapeutic Jurisprudence differs in several aspects from Swedish legal scholarship that follows Scandinavian Legal Realism. It is also demonstrated that Therapeutic Jurisprudence has several similarities with the so-called Proactive Approach. This paper suggests that Therapeutic Jurisprudence may serve as a useful legal theoretical perspective in Swedish legal scholarship, especially when studying complex and vague regulations with a future focus. Two examples from Swedish legislation are examined: (a) Laws regulating compulsory care of abused or neglected children, and (b) laws related to the mentally ill. This paper illustrates the complexity in these acts, and poses the question of whether the regulations serve their purpose of providing adequate care for and protection of those in need.
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| 38. |
- Kjellin, Lars, et al.
(författare)
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Compulsory psychiatric care in Sweden : development 1979-2002 and area variation
- 2008
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Ingår i: International Journal of Law and Psychiatry. - Amsterdam : Elsevier. - 0160-2527 .- 1873-6386. ; 31:1, s. 51-59
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Tidskriftsartikel (refereegranskat)abstract
- As in many other countries, the Swedish legislation on compulsory psychiatric care has been revised several times during the last four decades. Great regional differences within the country in the use of compulsory psychiatric care have been reported. The aims of this study were to describe the development of compulsory psychiatric care in Sweden 1979–2002, and to analyse differences between two groups of counties, one group with high and one with low civil commitment rates, in terms of psychiatric care structure, resources and processes. Data on civil commitments and forensic psychiatric care in Sweden 1979–2002 were collected from public statistics. At least one responsible person in leading position (administrative manager or chief psychiatrist) in each of the included counties was interviewed. The total number of involuntarily hospitalised patients decreased about 80% between censuses in 1979 and 2002, but the rates of forensic patients were unchanged. No clear-cut differences were found in the analyses of structure, resources and processes of psychiatric services between counties with high and counties with low levels of compulsory care. The equality before the law may be questioned. The importance of leadership is emphasised for future analyses.
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| 39. |
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| 40. |
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| 41. |
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| 42. |
- Larsson Lindahl, Marianne, et al.
(författare)
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Experiences of coercion during investigation and treatment.
- 2005
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier BV. - 0160-2527. ; 28:6, s. 613-621
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Tidskriftsartikel (refereegranskat)abstract
- According to Swedish legislation (LVM) compulsory treatment shall be decided on if someone, due to ongoing abuse of alcohol, drugs or volatile solvents, is in need of care to overcome abuse and if a voluntary intervention is not possible. Very little research has been conducted in Sweden on this particular legislation with regard to the clients' experiences of entire process from assessment to aftercare. We interviewed 74 subjects who were being assessed prior to the court's decision on involuntary care (n = 39), or with previous experience of assessment and involuntary care (n = 35). The assessment group more often reported having the opportunity to express their opinions to the social worker during the assessment period (55% vs. 21%, p < .05) and they were more positive towards the final decision (60% vs. 24%, p < .05). In spite of the law, 18% were not contacted by the social services while in coercive treatment. The clients who did meet with a social worker, often described the conferences as more of a perfunctory nature with a lack of focus on the actual situation and aftercare planning. This study points at a need of studying the subjects' experiences of the whole continuum of the coercive process: from the investigation, to treatment and to aftercare. It also points at the need for new instruments to be developed covering all aspects of the coercive process and in particular the period of investigation prior to the decision on involuntary care.
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| 43. |
- Laurell, Jenny, et al.
(författare)
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Psychopathy (PCL-R) in a forensic psychiatric sample of homicide offenders : Some reliability issues
- 2007
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier BV. - 0160-2527 .- 1873-6386. ; 30:2, s. 127-135
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Tidskriftsartikel (refereegranskat)abstract
- Several studies have shown that psychopathy is overrepresented among homicide offenders. There is a consensus that Hare's Psychopathy Checklist-Revised PCL-R is currently the most valid and useful tool for rating psychopathy (e.g., [Fulero, S. M. (1995). Review of the Hare Psychopathy Checklist-Revised. In J. C. Conoley & J. C. Impara (Eds.), Twelfth Mental Measurements Yearbook (pp. 453-454). Lincoln, NE: Buros Institute]). Usually, when making a rating of psychopathy, both an interview and an examination of the subject's files are used. However, it has been discussed what is really required to be able to rate psychopathy in a reliable manner. The aim of the present study was to retrospectively rate the degree of psychopathy in 35 homicide offenders being subjected to forensic psychiatric assessment. These ratings of psychopathy were carried out using forensic psychiatric files and courts'; verdicts only. Another aim was to examine the reliability of PCL-R in this specific Swedish sample of homicide offenders. There was a good agreement between the two raters with respect to the categorical diagnosis of psychopathy (Cohen's kappa=.81, p<.001), which indicates that retrospective ratings of psychopathy are well suited for research purposes. The prevalence of psychopathy among the homicide offenders was 31.4% (using a cut-off score of 30), which means that the construct of psychopathy may contribute to the understanding of the phenomenon of homicide. In the planning of treatment for homicide offenders, a consideration of possible psychopathy is necessary. As criminal psychopaths are known to relapse into violent criminality, it is very important that they are given efficient treatment, placement and management.
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| 44. |
- Laurell, Jenny, et al.
(författare)
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Recidivism is related to psychopathy (PCL-R) in a group of men convicted of homicide
- 2005
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier BV. - 0160-2527. ; 28:3, s. 255-268
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Tidskriftsartikel (refereegranskat)abstract
- It is well known that psychopaths are a group with high risk for criminality. Despite that, researchers and clinicians have not yet agreed on a general cause of psychopathy. However Raine [Raine, A. (2002). Biosocial studies of antisocial and violent behavior in children and adults: A review. Journal of Abnormal Child Psychology, 30, 311-326.] advocated a biosocial model of violent behaviour where the greatest risk for criminal behaviour occurred when both heredity and environmental risk factors (e.g., social class, childhood history) were present. In this follow-up study, 35 men convicted of homicide were assessed retrospectively for psychopathy according to the Psychopathy Checklist-Revised (PCL-R). Information on personal history, as well as from legal documents and records of offences committed by the subjects was also obtained. Fourteen of the 35 men were classified as psychopaths. Two men, both rated as psychopaths, had criminal parents. Twenty-seven of the men had a social relationship with their victim, and eleven out of these were rated as psychopaths. There was no difference in PCL-R scores between those who had a social relationship with their victim and those who did not. The psychopaths relapsed more frequently than the nonpsychopaths into criminality after their prison term. This result confirms previous research indicating that psychopathy is a risk factor for recidivism. It is, therefore, very important that psychopaths get the best possible treatment, aftercare, and supervision.
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| 45. |
- Levin, Sara, 1974-, et al.
(författare)
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Adherence to planned risk management interventions in Swedish forensic care : What is said and done according to patient records
- 2019
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier. - 0160-2527 .- 1873-6386. ; 64, s. 71-82
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Tidskriftsartikel (refereegranskat)abstract
- Both structured and unstructured clinical risk assessments within forensic care aim to prevent violence by informing risk management, but research about their preventive role is inconclusive. The aim of this study was to investigate risk management interventions that were planned and realized during forensic care by analysing patient records. Records from a forensic clinic in Sweden, covering 14 patients and 526 months, were reviewed. Eight main types of risk management interventions were evaluated by content analysis: monitoring, supervision, assessment, treatment, victim protection, acute coercion, security level and police interventions. Most planned risk management interventions were realized, both in structured and clinical risk assessments. However, most realized interventions were not planned, making them more open to subjective decisions. Analysing risk management interventions actually planned and realized in clinical settings can reveal the preventive role of structured risk assessments and how different interventions mediate violence risk.
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| 46. |
- Lund, Christina, et al.
(författare)
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Violent criminal recidivism in mentally disordered offenders: A follow-up study of 13-20 years through different sanctions
- 2013
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier BV. - 0160-2527. ; 36:3-4, s. 250-257
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To describe criminal recidivism, especially violent recidivism, in a long-term follow-up of mentally disordered offenders sentenced to different types of sanctions. Subjects and methods: A population-based Swedish cohort of male offenders referred to pre-trial psychiatric investigations between 1988 and 1995, was sentenced to forensic psychiatric treatment (n = 163), prison (n = 120), or noncustodial sanctions (n = 52). They were followed from the beginning of their sanctions until the end of June, 2008, through official health and crime registers. Survival analyses were used to compare time until violent recidivism across different sanctions and mental disorders, and predictors of violent recidivism were investigated using univariate comparisons, a multivariate Cox regression analysis and Receiver Operating Characteristic (ROC) curves. Finally, all criminal reconvictions until the end of follow-up were assessed (a total time period of 13 to 20 years). Results: Forty-seven percent of all subjects were reconvicted for violent crimes during follow-up. There were no significant differences between sanction groups. By contrast, diagnostic groups that included substance abuse had significant effects, and stood out as the strongest predictor of violent reconvictions together with the number of previous violent crimes, and age at the first registered criminal offence. Variables identified in the multivariate model together predicted violent recidivism with an area under the ROC curve of 0.72, while the corresponding figure for the age at onset of criminality as the sole predictor was 0.71. Among the different sanction forms for different time periods, time in hospital and prison were significantly less associated with violent recidivism compared to time in conditional release/probation.
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| 47. |
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| 48. |
- Malmgren, Helge, 1945, et al.
(författare)
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A philosophical view on concepts in psychiatry
- 2010
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier BV. - 0160-2527. ; 33, s. 66-72
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Tidskriftsartikel (refereegranskat)abstract
- This essay first outlines a philosophical theory of concepts and then applies it to two areas of relevance to psychiatrists, especially forensic psychiatrists. In the philosophical theory, the respective roles of verbal and non-verbal definitions are illuminated, and the importance of the phenomenon of division of semantic labour is stressed. It is pointed out that vagueness and ambiguity of a term often result when the term is used for several practical purposes at the same time. Such multi-purpose uses of terms may explain both the current problems associated with the Swedish forensic–psychiatric concept of a severe mental disorder and some of the shortcomings of DSM-IV.
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| 49. |
- Maycraft Kall, Wendy Katherine, 1962-
(författare)
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Same law - same rights? : Analyzing why Sweden's disability legislation failed to create equal rights in mental health
- 2014
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Ingår i: International Journal of Law and Psychiatry. - Oxford : Pergamon Press. - 0160-2527 .- 1873-6386. ; 37:6, s. 609-618
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Tidskriftsartikel (refereegranskat)abstract
- This article analyzed the apparent paradox of disability rights in Sweden. Despite strong welfare state traditions and stated Government ambitions to create generous statutory entitlements for all disabled people using a single, comprehensive Disability Act, psychiatric disabilities were principally excluded from the Disability Act's rights and provisions. The study focused on Sweden's Mental Health Reform and Disability Reform using governance perspectives that traced and analyzed the policy-processes of both reforms. Theoretically guided analytical frameworks were developed to help understand the divergent reform outcomes. The first focused on legislative arguments of regulatory specificity and legal enforcement mechanisms to consider whether the Disability Act was formulated in a manner that was easier to apply to certain disabilities. The second analyzed ideological arguments and the influence of Government political beliefs that signaled specific reform ‘visions’ to implementers and thereby influenced policy implementation. The main findings are that both perspectives matter as the dual influences of legislative and ideological differences tended to exclude mental health service users from the Act's generous disability rights. The overall conclusion was that while legislation was an important regulatory mechanism, the Government's underlying ideological reform vision was also an essential governance instrument that signaled Government intentions to implementing agencies and thus influenced the creation of enduring disability rights.
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| 50. |
- Nilsson, Anna
(författare)
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Unlocking the impact of the CRPD on Swedish mental health law
- 2024
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Ingår i: International Journal of Law and Psychiatry. - 0160-2527. ; 93
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Tidskriftsartikel (refereegranskat)abstract
- The Convention on the Rights of Persons with Disabilities (CRPD) sets out a new vision for mental health care with equality and self-determination as its core standards. The CRPD fundamentally challenges long-standing practices in Sweden including the use of involuntary hospitalization, treatment without consent, and the use of restraints. This article discusses the impact of this new vision on Swedish mental health law and policy. An examination of mental health law inquiries from 2008 to 2023 reveals a notable lack of attention from policymakers towards the CRPD. Nevertheless, the Convention has emerged as a vital advocacy instrument for disability organizations and others opposing proposals that seek to broaden doctors' authority to employ coercion. In addition, the many efforts undertaken to reduce the use of coercion and to enhance the involvement of individuals with psychosocial disabilities in policy development align seamlessly with the principles of the Convention. This article concludes with a reflection on why the CRPD has not assumed a more prominent role in shaping mental health law in Sweden and calls on the government to seriously consider the CRPD’s call for equality.
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