From Moral Insanity to Psychopathy

Psychopathy is currently a condition that arouses great interest among psychiatrists because of its significant involvement in the forensic field. The authors illustrate the course over time of the concept of psychopathy, starting from the definition of “moral insanity” of Prichard. The historical journey allows to illustrate the different positions that the various European schools of psychiatry have had toward psychopathy, until modern nosographic classification systems such as Diagnostic and Statistical Manual of Mental Disorders (DSM). Special attention is paid to the “core” of psychopathy: the alteration of the moral sense, and through the illustration of moral development is provided a reading of morality in the psychopath and the reasons for its impairment. A clinical and critical examination of psychopathy assessment scales is proposed, with the aim to broaden the horizons of assessment, also to individuals who do not show violent behavior, but with compromised moral sense. Lastly, authors propose an interpretation of the social aspects of psychopathy that goes beyond the assessment of the psychopath confined in jails, with several highlighted aspects of psychopathy that contribute to social success in work, relationships, and career and that can contribute to the success of the psychopath

Colloquio psichiatrico e credulità terapeutica nelle istituzioni penitenziarie

The purpose of the present study is demonstrating - through the description of twelve clinical cases - that patients in prison may lie to their therapists and give them false information. A psychiatrist working in a penitentiary institute should remember that a patient may give false information for different reasons: defence of his/her own life, protection of his/her physical integrity, desire to hide a crime committed in jail or to avoid or shorten a condemnation, personal advantage, recreational purpose, masked desire for violence, need to be accepted, need of a physical contact, malingering, deception, social visibility and acceptance. Therefore, it is important to examine the information given by patients and the anthropologic, sociologic and psychologic patterns of penitentiary life in a critical way, in order to achieve a better contextualization of clinical observation.Oggetto del presente studio è di illustrare, attraverso la descrizione di dodici casi clinici esemplificativi, la possibilità che lo psichiatra, nel suo colloquio clinico con pazienti in istituzione carceraria, riceva da questi errate informazioni. È importante, per lo psichiatra che opera in un’istituzione penitenziaria, sapere che il paziente può fornire informazioni di interesse psichiatrico, che non corrispondono al vero per vari motivi, tra cui: la difesa della propria vita, la protezione della sua integrità fisica, il desiderio di nascondere un reato commesso in carcere, uno stratagemma per evitare od abbreviare la durata della pena, l’ottenimento di un beneficio personale, un’opportunità ludica da sfruttare, la verbalizzazione mascherata di desideri di violenza, il bisogno di essere accettato, la ricerca del contatto fisico rassicurante, la simulazione consapevole ed inconsapevole, la dissimulazione per evitare conflitti, la presentazione del proprio doppio. È importante, quindi, che lo psichiatra che opera in carcere esamini ed approfondisca sempre con critica le informazioni che vengono fornite dal paziente e che conosca gli aspetti antropo-socio-psicologici della vita penitenziaria, per meglio contestualizzare le sue osservazioni psichiatriche

Sexual violence and eclampsia: analysis of data from Demographic and Health Surveys from seven low- and middle-income countries.

BACKGROUND: Scientific literature has provided clear evidence of the profound impact of sexual violence on women's health, such as somatic disorders and mental adverse outcomes. However, consequences related to obstetric complications are not yet completely clarified. This study aimed to assess the association of lifetime exposure to intimate partner sexual violence with eclampsia. METHODS: We considered all the seven Demographic and Health Surveys (DHS) that included data on sexual violence and on signs and symptoms suggestive of eclampsia for women of reproductive age (15-49 years). We computed unadjusted and adjusted odds ratios (OR) to evaluate the risk of suggestive eclampsia by ever subjected to sexual violence. A sensitivity analysis was conducted restricting the study population to women who had their last live birth over the 12 months before the interview. RESULTS: Self-reported experience of sexual violence ranged from 3.7% in Mali to 9.2% in India while prevalence of women reporting signs and symptoms compatible with eclampsia ranged from 14.3% in Afghanistan to 0.7% in the Philippines. Reported sexual violence was associated with a 2-fold increased odd of signs and symptoms suggestive of eclampsia in the pooled analysis. The sensitivity analysis confirmed the strength of the association between sexual violence and eclampsia in Afghanistan and in India. CONCLUSIONS: Women and girls in low-and-middle-income countries are at high risk of sexual violence, which may represent a risk factor for hypertensive obstetric complication. Accurate counseling by health care providers during antenatal care consultations may represent an important opportunity to prevent adverse outcomes during pregnancy

La Responsabilità forense dello psichiatra in tema di suicidio

The psychiatrist’s forensic responsibility about suicide is a topical theme today. The psychiatrist must get a move on a therapeutic space that provides the patient healthcare reducting suicide risk rate, complying with individual freedom and rights. In this work we explain some forensic topics about responsibility and some of the most common reasons of report on the psychiatrist charge. The goal of a descriptive-clinical approach is to widen the knowledge of the topic, avoiding a self-defensing attitude and complying with a good clinical practice. La responsabilità forense dello psichiatra in tema di suicidio è una problematica di sempre maggior attualità. Lo psichiatra deve muoversi in uno spazio terapeutico che prevede la tutela della salute del paziente attraverso la riduzione del rischio suicidario nel rispetto della libertà individuale e dei diritti dell’individuo. Nel presente lavoro vengono illustrate alcune problematiche forensi in tema di responsabilità ed alcune tra le motivazioni più frequenti che determinano la denuncia agli psichiatri. L’approccio descrittivo-clinico ha come obiettivo uno stimolo all’approfondimento della problematica senza sconfinare in una psichiatria difensiva, nel rispetto di una buona pratica clinica

Le reazioni emotive al colloquio con l’omicida

The most frequent emotional reactions of an interlocutor (criminologist, psychiatrist, magistrate, etc.) to the interview with a murderer are here described from a clinical qualitative point of view. The work deals in particular with the emotional reactions of the interlocutor about: a) violent behaviour; b) mental psychopathology; c) absence of mental psychopathology; d) murderer's defensive mechanism; e) the transformation of the victim's image; f) the interpersonal relationship between the murderer and the interlocutor; g) the use of the interview in different contexts (judicial, psychiatrical, custodial, ecc.). The knowledge of these emotive reactions could be useful for a better understanding (by all the institutional figures that have contacts with murderers) of criminal-genesis and criminal-dynamics and for the improvement of the quality of evalutation and treatment, as well as for a correct forensis interpretation of clinical cases.Sono descritte, sotto l’aspetto clinico qualitativo, le più frequenti reazioni emotive che un interlocutore (criminologo, psichiatra, psicologo, magistrato, ecc.) può provare nel colloquio con un soggetto che ha commesso un omicidio. In particolare sono state esaminate le reazioni emotive dell’interlocutore nei confronti: a) del comportamento violento; b) della psicopatologia mentale; c) dell’assenza della patologia mentale; d) dei meccanismi di difesa utilizzati dall’omicida; e) della trasformazione dell’immagine della vittima; f) della relazione interpersonale tra omicida e interlocutore; g) della rinarrazione del racconto dell’omicidio e della sua utilizzazione in differenti sedi (giudiziaria, psichiatrica, custodiale, ecc.). La conoscenza di queste reazioni emotive può essere di utilità per tutte le figure istituzionali che hanno contatto con persone che hanno compiuto un omicidio, allo scopo di meglio comprenderne la criminogenesi e la criminodinamica, di migliorare la qualità della valutazione e del trattamento e di formulare una corretta interpretazione forense del caso clinico

Colloquio psichiatrico e capro espiatorio nelle istituzioni penitenziarie

The psychiatric interview in jail, between mental health professionals (psychiatrist, criminologist, psychologist, social worker, ecc.) and patients often shows the tendency to identify the responsibility for his deprivation of freedom, or physical and psychological sufferings, with other people or groups. These people are called enemy by patient, and can be the objective of physical violence, as a scapegoat. In these enemies or scapegoats we can put also mental health professionals. The subject matter of the present article is to describe six dynamics that allow to study in detail the creation of the enemy made by patients in penitentiary institutes: 1) The acute creation of a real enemy for a real fact; 2) The progressive and self-serving creation of an enemy; 3) An aggressive manner to control an environment seen as violent and unrestrainable; 4) An opportunity to assault the symbols of the establishment; 5) The fulfilement of the possibility to judge or punish the others in spite of being punished or judged by them; 6) The attempt to thwart the inner aggressiveness of the group. The purpose of this study is to better the mental health operators professional skills through the knowledge of their emotions when they are seen as enemies, to avoid iatrogenic injures caused by unsuited emotional responses, to understand how to use the patient’s creation of an enemy as a way to make diagnosis in a deeper way, and to better the therapeutic intervention on the patient.Il colloquio in istituzione penitenziaria fra operatore della salute mentale (psichiatra, criminologo, psicologo, assistente sociale, ecc.) e paziente, mette spesso in luce la tendenza di quest’ultimo ad identificare, in altre persone od altri gruppi, la responsabilità per la sua privazione di libertà e per le sue sofferenze psichiche e fisiche. Queste persone sono qualificate dal paziente come nemiche e nei loro confronti, come un capro espiatorio, possono essere messe in atto anche delle violenze fisiche. Tra questi nemici o capri espiatori vi possono anche essere gli operatori della salute mentale. Oggetto del presente studio è la illustrazione di sei dinamiche che permettono di approfondire la conoscenza della creazione del nemico da parte del paziente nei colloqui con gli operatori della salute mentale in istituzione penitenziaria: 1) La creazione acuta di un nemico reale per un fatto reale; 2) La creazione progressiva e pretestuosa di un nemico; 3) Una modalità aggressiva per controllare un ambiente ritenuto aggressivo e incontrollabile; 4) L’opportunità per aggredire i simboli di ciò che si odia; 5) La gratificazione di poter giudicare e punire gli altri, invece di essere giudicato e punito dagli altri; 6) Il tentativo di neutralizzare l’aggressività intragruppale. Lo scopo del presente studio è quello di migliorare la formazione professionale degli operatori della salute mentale in carcere attraverso la consapevolezza delle loro emozioni, allorquando sono considerati nemici, evitare errori iatrogeni legati a reazioni emotive inadeguate, e saper utilizzare la creazione di un nemico da parte del paziente come un mezzo per approfondire la diagnosi e migliorare l’intervento terapeutico sul paziente

La Traslazione del paziente, con disturbo mentale e comportamento violento, verso il terapeuta

We described eleven typical clinical cases of patients’ translational typology with mental disorder and violent behaviour towards the therapist. The clinical cases described exhibit neurotic and psychotic translation linked to translation linked to mental disorder and translation linked to the aetiology and to the dynamics of violent behaviour. The objective of this clinical study is to enrich the psychiatric diagnosis and therapeutic pathways of patients with mental disorder and violent behaviour and to avoid iatrogenic error by using the concept of translation in its widest understanding

La Controtraslazione del terapeuta verso il paziente con disturbo mentale e comportamento violento

We described thirteen typologies of the therapist countertransference toward the patient with mental disorder and violent behavior. The purpose of this study is to improve: a) the ability of the therapist to mentalize emotions without any passing to the act; b) the recognition of the patient transference; c) the recognition of the countertransference related to mental disorder and violent behavior

Reattività inadeguata del terapeuta nei confronti del paziente a rischio suicidario = Therapist’s reactions on the treatment of suicidal patients

In the present study, we describe fourteen therapists’ reactions (Avoidance, Rejection, Suicidal collusion, Overinvolvement, Overprotection, Loss of patients’ responsibilities, Loss of therapists’ responsibilities, Reaction to the feeling of being exploited, Creation of dependency, Manipolatory acting out, Feeling of undergoing an iniquity, Patients psychopathology inflation, Therapists’ psychopathology inflation, Suicidal Burnout Syndrome), based on emotions, behaviors and cognitivity, toward patients with suicidal risk. These responses can interfere with a correct assessment and management of suicidal risk in psychiatric patients. The purpose of the present clinical study was to improve therapist’s professional skills through the recognizement and management of his own responses to suicidal patients