Lying in the medicolegal field: Malingering and psychodiagnostic assessment

The simulation of mental illness, so-called “Malingering”, is a very difficult phenomenon for professionals to identify when making an assessment, especially in the medicolegal and forensic psychology and psychiatry fields. When malingering, the subject implements strategies that mimic the symptoms related to a possible psychiatric disease, with the aim of misleading the operator. It is necessary, therefore, to elicit a complete medical history and make a close clinical examination and, especially, to be able to rely on appropriate diagnostic tools. Another important aspect, in the legal medicine, and forensic psychology and psychiatry fields, is the opposite strategy, namely that of dissimulating, or masking, a disease.Several diagnostic tools that the professional clinician can employ to identify dissembling strategies are considered in this article, namely the MMPI- 2, PAI, M- Fast, the SIRS and, finally, the SIMS. Clin Ter 2019; 170(2):e134-141. doi: 10.7417/CT.2019.212

Evocative gene-environment correlation between genetic risk for schizophrenia and bullying victimization

Bullying exposure concerns over 10% of adolescents in Europe. Moreover, bullying victimization is heritable and victims are liable to psychotic symptoms, partly because of shared heritability with psychosis. The genetic component of bullying victimization has been proposed to involve the social reactions elicited by victims – a mechanism called “evocative gene-environment correlation”. We hypothesized that genetic risk for schizophrenia, a heritable disease also associated with social stress during childhood and adolescence, is related with social experiences during adolescence and is involved in the risk of developing psychotic symptoms. We studied 908 individuals of the TRAILS sample and found that 13-14-year-old adolescents with greater genetic risk for schizophrenia are more exposed to bullying assessed via peer nomination scores than their peers with lower genetic risk. Importantly, bullying victimization mediated the path from genetic risk to the frequency of psychotic symptoms about three years later. These findings provide evidence of a previously unreported form of gene-environment interplay that may be a mechanism of risk for psychosis and schizophrenia. To the extent that genetic risk translation into clinical symptoms is mediated by environmental risk factors, this evidence supports mental health prevention aimed at antagonizing bullying victimization in vulnerable individuals

Spatial Mental Transformation Skills Discriminate Fitness to Drive in Young and Old Adults

Literature on driving research suggests a relationship between cognition and driving performance in older and younger drivers. There is little research on adults and driving, despite them being the largest age cohort behind the wheel. Among the cognitive domains, visuospatial abilities are expected to be highly predictive of driving skills and driving fitness. The relationship between specific spatial mental transformation skills (i.e., object and self-based ones) and driving performance has not yet been examined. The present study aimed to investigate the relationship between overall cognitive functioning, self and object-based spatial mental transformation skills, and driving performance in a sample of younger and older adult drivers. Participants were comprised of one hundred younger and 83 older adult Italian drivers. Participants completed a computerized driving test assessing traffic stress resilience, visual and motor reaction time, and the ability to obtain an overview of the traffic scenario (DT, vRT, mRT, and ATAV respectively in the Shufried®-Vienna Test System–DRIVESC). The Mental Rotation Test (MRT) and the Object Perspective Taking Test (OPT) were administered in order to assess object-based and self-based spatial mental transformation skills. The Montreal Cognitive Assessment Test (MoCA) was administered control for global cognitive functioning. The effects of education and gender were also controlled in the analysis. The results of the present study suggested that: (1) The effect of age, favoring younger participants, was found in DT, vRT, mRT, and ATAVT tests. (2) The effect of global cognitive functioning was found in DT and ATAV tests. (3) The effect of the spatial mental transformation tests was found in DT, vRT (MRT only), and ATAVT (OPT only) tests. Taken together, these results suggest the specific contribution of spatial mental transformation skills in the execution of complex behaviors connected to the fitness to drive. Prospectively, the results of the present study relating spatial mental transformation skills and driving processes may be a valuable source of knowledge for researchers dealing with the relationship between cognitive resources and navigation aids

La genitorialità reclusa: essere padri in carcere

Essere padri detenuti rientra nella categoria di genitorialità a rischio, in quanto la condizione di detenzione fa venire meno alcuni presupposti fondamentali dell’esercizio della funzione genitoriale. Il genitore dovrebbe riuscire trasmettere al bambino fiducia nelle sue capacità di crescita perché il bambino si nutre di questo e non di tutte le cose che gli possono essere date materialmente (Bouregba, 2004)1. Per i detenuti, la famiglia, molto spesso, costituisce la più importante fonte di speranza, benessere e legame con l’esterno (Magaletta, Herbst, 2001)2. Ma l'ingresso in carcere interrompe ed altera la natura bidirezionale e reciproca dello scambio comunicativo e interattivo genitore-figlio. Un padre detenuto non può esercitare nella contiguità fisica, spaziale e temporale il ruolo di genitore. Va inoltre considerato che stereotipi e pregiudizi possono contribuire a creare una rappresentazione culturalmente condivisa del detenuto come soggetto incapace di essere un buon genitore, e ciò potrebbe determinare, nei soggetti in questione, un vissuto di fallimento e di inadeguatezza rispetto alla percezione di sé come padre e al proprio ruolo (Cassibba, Luchinovich, Montatore, Godelli, 2008)3. Inoltre l’assenza di modelli di riferimento adeguati, le condizioni iniziali di svantaggio, la povertà degli strumenti cognitivi, comunicativi e relazionali disponibili, uniti all’esperienza di un contesto restrittivo quale il carcere, rendono difficile la costruzione e il mantenimento di un legame fra padre-figlio adeguato alle esigenze di sviluppo del minore e stabile nel tempo (Cassibba et al, op cit, 2008). Sulla base di tale impostazione teorico-concettuale, l'obiettivo del presente contributo è quello di presentare i dati preliminari di una ricerca che ha visto la collaborazione tra l'Università di Bari e di Modena e Reggio Emilia, coinvolgendo nel contempo le amministrazioni penitenziarie delle due rispettive regioni, con lo scopo di indagare l'auto-percezione del ruolo paterno in padri in stato detentivo, esplorando nel contempo la relazione tra tale forma di auto-percezione e lo stile di attaccamento dei partecipanti alla ricerca. Dal punto di vista metodologico, per la misurazione delle variabili in oggetto sono stati utilizzati l'Attachment Style Questionnaire- ASQ (Feeney, Noller e Hanrahan, 1994) e il questionario sull'Auto-percezione del Ruolo Paterno (Harter, 1982)

Undetected patricide: Inaccuracy of cause of death determination without an autopsy

Patricide (killing the father) is uncommon form of homicide. Usually the assaults occur at home in the absence of witnesses and adult sons are frequently involved. Homicides in a domestic context usually do not tend to recurrence, because the motivation for the crime ends with the death of the parent. However, this is not what was observed in the present case study dealing with the death of a 70 years old white man originally misclassified as accident and discovered three years later only after an additional homicide in a family context of a 60 years old white lady. Multiple stab wounds to the neck and thorax were misinterpreted at the external male body examination as blunt trauma falling down stairs. No forensic autopsy was requested and no comparison of medical findings with the results from the death scene, such as a bloodstain analysis was performed by the police officers nor required by the judicial authority. This was quite surprising because an additional but preliminary post-mortem external examination performed by a general practitioner on the male body already raised the suspicion that the external lesions were stab wounds thus requiring a forensic autopsy. Only the exhumation of the elderly body, performed years later, confirmed the diagnostic hypothesis raised by the first physician. The present case is quite representative of a death investigation not run professionally and performed by individuals with no specific training where most of the medico-legal investigations (especially for traumatic and violent deaths) are restricted to an external body examination without subsequent autopsy. Although misinterpretation of external lesions is inevitable and significant discrepancies between external body examination and forensic autopsy are not rare, in the case of contradictory results of postmortem external examination or unclear/suspicious cause and manner of death, investigation should proceed necessarily with a forensic autopsy

Cognitive efficiency and fitness-to-drive along the lifespan: The mediation effect of visuospatial transformations

The way people represent and transform visuospatial information affects everyday activities including driving behavior. Mental rotation and perspective taking have recently been found to predict cognitive prerequisites for fitness-to-drive (FtD). We argue that the relationship between general cognitive status and FtD is mediated by spatial transformation skills. Here, we investigated the performance in the Mental Rotation Test (MRT) and the Perspective-Taking Test (PT) of 175 male active drivers (aged from 18 to 91 years), by administering the Montreal Cognitive Assessment (MoCA) to measure their global cognitive functioning. All participants were submitted to a com-puterized driving assessment measuring resilience of attention (DT), reaction speed (RS), motor speed (MS), and perceptual speed (ATAVT). Significant results were found for the effect of global cognitive functioning on perceptual speed through the full mediation of both mental rotation and perspective-taking skills. The indirect effect of global cognitive functioning through mental rotation was only found to significantly predict resilience of attention whereas the indirect effect mediated by perspective taking only was found to significantly predict perceptual speed. Finally, the negative effect of age was found on each driving measure. Results presented here, which are limited to male drivers, suggest that general cognitive efficiency is linked to spatial mental transformation skills and, in turn, to driving-related cognitive tasks, contributing to fitness-to-drive in the lifespan

Impact of COVID-19 emergency on the psychological well-being of susceptible individuals

The current pandemic has exerted an unprecedented psychological impact on the world population, and its effects on mental health are a growing concern. The present study aims to evaluate psychological well-being (PWB) during the COVID-19 crisis in university workers with one or more diseases likely to increase the risk of severe outcomes in the event of SARS-CoV-2 infection, defined as susceptible. 210 susceptible employees of an Italian University (aged 25-71 years) were recruited during the COVID-19 second wave (October-December 2020). A group comprising 90 healthy university employees (aged 26-69 years) was also recruited. The self-report Psychological General Well Being Index (PGWBI) was used to assess global PWB and the influence on six sub-domains: anxiety, depressed mood, positive well-being, self-control, general health, and vitality. We applied non-linear dimension-reduction techniques and regression methods to 45 variables in order to assess the main demographic, occupational, and general-health-related factors predicting PWB during the COVID-19 crisis. PGWBI score was higher in susceptible than in healthy workers, both as total score (mean 77.8 vs 71.3) and across almost all subscales. Age and jobs involving high social interaction before the pandemic were inversely associated with the PWB total score, general health, and self-control subscores. The current data suggest no decline in PWB during the second wave of COVID-19 health emergency in susceptible individuals of working age. Critically, higher risk for mental-health issues appears to be inversely related to age, particularly among individuals deprived of their previous level of social interaction at work

A para-religious setting for financial exploitation of the mentally incapacitated: when the habit doesn’t make a monk

Exploitation and circumvention of the mentally incapacitated is a criminal offence listed in the Italian penal code (Penal Code Art. 643). It involves the exploitation and circumvention of people who are fragile and vulnerable owing to their health conditions and/or mental status, and fits into the grey area between such subjects’ freedom to make decisions about their physical conditions and economic assets, and the abuse of their trust perpetrated by third parties for personal gain. The authors describe a case of financial exploitation and circumvention of a married couple that is remarkable in view of both the huge sums extorted from the victims and the duration of the peculiar illicit activities (that lasted more than 10 years). These were perpetrated by a charismatic figure leading a “para-religious” group. He claimed to be a prophet, but his private life was highly questionable. The method of ascertainment used to verify the victims’ mentally incapacitated state is described, analyzed and commented; the diagnosis could not be deferred in view of the characteristics of the prolonged penal offences committe

Utility of noninvasive methods for the characterization of nonalcoholic liver steatosis in the family practice. The "VARES" Italian multicenter study.

The diagnostic utilities of ultrasonography (US), fatty liver index (FLI) and an algorithm of nine serum markers (Fibromax) were evaluated in family practice to noninvasively characterize patients with nonalcoholic fatty liver disease (NAFLD). A multicenter study was conducted by enrolling 259 consecutively observed patients (age 51 ± 10 years) with clinical and ultrasonographic features of NAFLD . Patients had mild (16.2%), moderate (69.9%), or severe (13.9%) liver steatosis and 60.2% had hypertransaminasemia. The percent of patients with overweight, obesity, diabetes, hypertension, and dyslipidemia were 42.7%, 46.5% (4.2% severe obesity), 24.7%, 40.9%, and 56.4% , respectively. Lean patients (10.8%) had normal transaminases in two/ thirds of the cases. A multivariate logistic regression (including age > 50 yrs, BMI > 30 kg/m 2 , HOMA > 3, and hypertransaminasemia) identified 12.3% of patients at risk for steatohepatitis. With a sensitivity of 50% and specificity of 94.7%, Fibromax identified 34 patients (13.1%) with likely advanced fibrosis and found that over 28% of patients with moderate (ultrasonographic) steatosis were likely to be carrying severe steatosis. Steatotest score was significantly associated with BMI, waist circumference, ALT, triglycerides, and FLI. Fibrotest correlated only with ALT. FLI identified 73.4% of patients as likely to be carrying a fatty liver. In conclusion, NAFLD should be systematically searched and characterized in all patients with metabolic disturbances and cardiovascular risk. Asymptomatic subjects at risk also should be screened for NAFLD. Fibromax is a promising noninvasive diagnostic tool in family medicine for identifying patients at risk for NAFLD who require targeted follow-up

Radicalization in Correctional Systems: A Scoping Review of the Literature Evaluating the Effectiveness of Preventing and Countering Interventions

Although several prevention and countering radicalization programs in correctional institutions have been carried out in Europe and worldwide, little is known about their effectiveness. Thus, the current scoping review aimed at reporting on the state of the art of the literature assessing and evaluating such actions, identifying knowledge gaps, and examining methods used to assess their successfulness and impact. A total of eight studies that met eligibility criteria were reviewed after performing a search on Scopus, Web of Science, and PsychInfo (Ebsco) databases: Two studies evaluated a reintegration initiative based in the Netherlands; four focused on an Australian disengagement program; and two offered insights on a rehabilitation program carried out in Sri Lanka. Findings were discussed according to their evaluation methods (qualitative, mixed-methods, and quantitative) and instruments. Results highlighted that the evaluation process is still confronted with several methodological difficulties, such as a lack of agreement on how to univocally define and measure success and the identification of uniform indicators of deradicalization and disengagement. Additionally, results revealed that the effectiveness of these interventions is predominantly based on anecdotal evidence rather than on rigorous, empirical proofs. As such, it was not possible to compare these programs and determine which worked best. Suggestions for future research and practical implications for policymakers, prison governors, and practitioners are offered in the concluding section of this work