Dangerousness: Historic evolution and practice of the concept

The concept of dangerousness was created by the Positive School of Penal Law in the second half of the XIXth century. Since then, it has become one of the key concepts of the modern Penal Law.The Classical Penal Law School was oriented toward the severity of the delictuous act and its correspondent sentence. The Positive Criminal Law School took the delict as an indicator, a symptom of an abnormal personality. Although mainly dedicated for justifying discrimination and seclusion, its scientific orientation paved the way for etiologic thought that nowadays can be restored as a matter of rehabilitation for society - what was not a clear orientation by that days. Even then, however, the preventive mentality was already part of that approach, pointing out to the psychosocial factors as well as neurologic and genetic factors, which was not, however put into practice. It can be said that Classical Law used to deal with Crimes, while the Positive Law, with C riminals. This article presents the particular ways in which the historical evolution of the concept of dangerousness has affected the theory and the practice of Forensic Psychiatry until our days.O conceito de periculosidade nasceu no final do século XIX dentro da Escola Positiva do Direito Penal, tendo-se constituído o conceito-chave do Direito Penal moderno. O Direito Clássico detinha-se na gravidade do delito e na correspondente punição. Já a Escola Positiva do Direito Penal considerou o delito um indicador, um sintoma de personalidade anormal. Propunha-se, assim, o seu tratamento, com a subseqüente prevenção de novos delitos. O Direito Clássico, portanto, ocupava-se do Crime, e o Positivo, do Criminoso. A relevância dada pelo Direito Penal moderno ao tripé "delito, tratamento e prevenção", bem como à identidade entre crime e patologia, trouxe em si a necessidade premente da figura do psiquiatra. Desde então, a tentativa de elaboração de critérios objetivos para aferição da periculosidade de sujeitos infratores tem sido uma das tarefas principais da Psiquiatria Forense.O presente trabalho pretende demonstrar a maneira particular em que a evolução histórica do conceito de periculosidade afeta ainda hoje a teoria e a prática da Psiquiatria Forense

O exame de Verificação de Cessação de Periculosidade: a importância da avaliação ampliada em um caso com conclusão contrária ao parecer da equipe assistente

Trata-se de uma discussão a respeito de um caso em que um indivíduo sob medida de segurança, devido a tentativa de homicídio, foi submetido à avaliação de sua periculosidade por peritos psiquiatras. A conclusão foi de que sua periculosidade não havia cessado, divergindo da opinião de sua equipe assistente. Foram identificados relevantes fatores que implicam um maior risco de violência e reincidência criminal, demonstrados no laudo. O resultado mostra que uma avaliação criteriosa e independente é fundamental para a elaboração de um bom laudo psiquiátrico

Comportamento violento, gênero e psicopatologia

A violência cometida por indivíduos com transtornos mentais graves tem se tornado um foco crescente de interesse entre profissionais de saúde, autoridades policiais e outros segmentos da sociedade. Na população geral, os homens são mais agressivos do que as mulheres. Entretanto, tem sido encontrado que a diferença de gênero em relação ao comportamento violento é menor entre os indivíduos que apresentam transtornos mentais, comparados àqueles que não apresentam estes transtornos

Phenomenological aspects of the cognitive rumination construct

Objective: To evaluate the importance of phenomenological aspects of the cognitive rumination (CR) construct in current empirical psychiatric research.Method: We searched SciELO, Scopus, ScienceDirect, MEDLINE, OneFile (GALE), SpringerLink, Cambridge Journals and Web of Science between February and March of 2014 for studies whose title and topic included the following keywords: cognitive rumination; rumination response scale; and self-reflection. The inclusion criteria were: empirical clinical study; CR as the main object of investigation; and study that included a conceptual definition of CR. The studies selected were published in English in biomedical journals in the last 10 years. Our phenomenological analysis was based on Karl Jaspers' General Psychopathology.Results: Most current empirical studies adopt phenomenological cognitive elements in conceptual definitions. However, these elements do not seem to be carefully examined and are indistinctly understood as objective empirical factors that may be measured, which may contribute to misunderstandings about CR, erroneous interpretations of results and problematic theoretical models.Conclusion: Empirical studies fail when evaluating phenomenological aspects of the cognitive elements of the CR construct. Psychopathology and phenomenology may help define the characteristics of CR elements and may contribute to their understanding and hierarchical organization as a construct. A review of the psychopathology principles established by Jasper may clarify some of these issues

Schizophrenia and violence: study in a general psychiatric hospital with HCR-20 and MOAS

Abstract Objective: This preliminary study aimed to identify and compare characteristics related to violent behavior in inpatients with schizophrenia at a general psychiatric hospital using the Historical, Clinical, and Risk Management 20 (HCR-20), the Modified Overt Aggression Scale (MOAS), and sociodemographic data. Method: Violent and nonviolent participants were selected based on psychiatric admission reports. Participants with reports of aggressive behavior and HCR-20 total score ≥ 21 upon admission were assigned to the violent patient group. Participants without aggressive behavior and with HCR-20 total score < 21 upon admission were assigned to the nonviolent patient group. The MOAS was applied to characterize the degree of severity of the violent behavior. Results: HCR-20 and its subscales were effective in differentiating between the violent and nonviolent participant groups. Twelve of the 20 HCR-20 items were useful for distinguishing between the groups, although total HCR-20 scores were more reliable when applied to the nonviolent patient group. The MOAS did not show high degrees of severity for the types of aggression observed in the participants. Conclusion: HCR-20 was useful and reliable for distinguishing between violent and nonviolent patients with schizophrenia in this clinical psychiatric setting. Item analysis identified the most relevant characteristics in each group. The use of the HCR-20 in clinical psychiatric settings should be encouraged

Cessation of dangerousness status: an analysis of 224 reports from the Instituto de Perícias Heitor Carrilho, Rio de Janeiro, Brazil

Objectives: To evaluate factors related to dangerousness cessation at the end of involuntary commitment based on an analysis of expert reports. In light of the current legal requirement of dangerousness cessation as a pre-requisite for prison or internment release of individuals subjected to the safety measure, we sought elements to reflect on the practice of expert examiners in charge of making this decision. Methods: The authors revised 224 expert psychiatric dangerousness cessation reports released 2011 through 2014 and collected data for a statistical analysis. Results: The following variables were associated with positive risk cessation assessments: no inadequate behavior (according to the assistant professionals), no productive psychotic symptoms, no negative symptoms, presence of insight, presence of a support network, and no psychoactive substance abuse. The following variables were associated with negative dangerousness cessation decisions: early onset of malfunction, lack of insight, negative attitudes, active signs of major mental illness, presence of impulsiveness, poor response to treatment, presence of plans lacking feasibility, exposure to destabilizing factors, lack of personal support, and presence of stress. Conclusions: In this study we were able to identify factors associated with dangerousness in a sample of expert reports. The knowledge of factors linked to a higher risk of recidivism in illegal activities or violent behavior is crucial for decision-making regarding the release of offenders after their legally established period of involuntary commitment