Psicopatia in un campione di donne con infermità mentale accertata in sede giudiziaria italiana e ritenute socialmente pericolose

In this retrospective observational study, we aimed at investigating the presence and degree of psychopathy as well as its possible association with clinical characteristics in a sample of women detained in the Italian residence for the execution of security measure (REMS) of Castiglione delle Stiviere (Mantova, Italy). The 50 recruited women had been judged to be lacking criminal re-sponsibility or having substantially diminished responsibility and socially dangerous. A PCL-R total score cut-off > 25 was used to distinguish between patients with or without psychopathy. The analysis of the data highlighted significant associations between psychopathy and borderline personality disorder with comorbid substance abuse, crimes of theft or personal injury. Those patients who were detained due to homicide or attempted homicide and suffered from schizo-phrenia spectrum disorders showed lower PCL-R scores than others.In questo studio osservazionale retrospettivo, si è mirato ad indagare la presenza e il grado di psicopatia nonché la sua possibile associazione con le caratteristiche cliniche in un campione di donne internate nelle Residenze per l'esecuzione delle misure di sicurezza (REMS) di Castiglione delle Stiviere (Mantova, Italia). Le 50 donne reclutate erano state giudicate totalmente o parzialmente incapaci di intendere e di volere nonchè socialmente pericolose. Un punteggio totale PCL-R > 25 è stato utilizzato per distinguere tra pazienti con o senza psicopatia. L'analisi dei dati ha evidenziato associazioni significative tra psicopatia e disturbo borderline di personalità con disturbo da uso di sostanze in comorbilità, reati di furto o lesioni personali. Le pazienti che sono stati internate a causa di un omicidio o tentato omicidio e che erano affette da disturbi dello spettro schizofrenico hanno mostrato punteggi PCL-R inferiori rispetto alle altre

L'impatto della pandemia Covid-19 sulle nuove strutture psichiatrico-forensi in Italia

After the closure of Psychiatric Hospitals (OPs), in 2012 the Italian Government decided to close the High Security Psychiatric Hospitals (OPGs). Law 81/2014 established that each region would provide smaller forensic psychiatry facilities, theREMS (Residence for the Execution of the Security Measures), to accommodate socially dangerous NGRI (Not Guilty by Reason of Insanity) offenders. The main characteristic of a REMS is that it is purely therapeutic and rehabilitative in naturewhile remaining a custodial safety measure. The COVID-19 pandemic undoubtedly tested the organization of these new Italian forensic psychiatry facilities whose practices were not yet fully established, forcing them to ensure patient safety during lockdown amidst the epidemic. The Chapter V Constitutional reform which assigned each region exclusive competence for health policies in its own territory, once the prerogative of the central government, was also put to the test. To assess the impact of the pandemic on the new forensic care system in Italy, we conducted a semi-structured interview with REMS health professionals from various regions with differing levels of contagion: the Poli REMS di Castiglione delle Stiviere; the REMS of Volterra; the REMS of Carovigno and the REMS of Pisticci. The interview assessed how the rehabilitation objectiveshad been met notwithstanding the serious operational limitations consequent to COVID-19 related decisions by the authorities.Dopo la chiusura degli Ospedali Psichiatrici (OP), nel 2012 il Governo Italiano ha deciso di chiudere gli Ospedali Psichiatrici Giudiziari, gli OPG. La legge 81/2014 stabiliva che ogni regione avrebbe dovuto prevedere l’istituzione di strutture psichiatrico-forensi più piccole, le REMS (Residenze per la Esecuzione delle Misure di Sicurezza), per accogliere gli autori di reatonon imputabili, socialmente pericolosi. La caratteristica principale delle REMS è quella di avere una natura prettamente terapeutica e riabilitativa pur rimanendo una misura di sicurezza detentiva. Non c’è dubbio che la pandemia COVID-19 abbia messo alla prova l’organizzazione delle nuove strutture psichiatrico-forensi italiane, con prassi ancora non del tutto consolidate, costringendo le REMS durante il lock-down ad adoperarsi per gestire l’epidemia, garantendo al tempo stesso la sicurezza dei pazienti. In questo contesto è stata messa alla prova anche la riforma del Capitolo V della Costituzione, che assegnava a ciascuna Regione la competenza esclusiva per le politiche sanitarie del proprio territorio, un tempo prerogativa del governo centrale. Alla luce di ciò, per valutare l’impatto della pandemia sul nuovo sistema di assistenza forense in Italia, abbiamo condotto un’intervista strutturata con gli operatori sanitari delle REMS di diverse regioni con diversi livelli di diffusione della malattia: la Poli REMS di Castiglione delle Stiviere; la REMS di Volterra; la REMS di Carovigno e la REMS di Pisticci. L’intervista ha valutato come gli obiettivi riabilitativi fossero stati garantiti nonostante i gravi limiti operativi conseguenti alle decisioni delle autorità determinate dal COVID-19

Il percorso psicoterapico della madre figlicida in ambito forense

This research brings together the experience of forensic facilities of Castiglione Delle Stiviere (Italy) during the psychotherapeutic treatments carried out on female patiens charged with filicide, who were under custody security measures. For that purpose, a specif interview was administered to psychologists who, from 1999 to 2019 have accomplished the treatments, in order to identify the main common steps. Data analysis showed the following effects as recurring: estabilishing of a therapeutic alliance, evaluation of psychic status, target sharing, felony processing, the involvement of support network and the path to discharge. Unanimous thoughts also rose about the role of public opinion in psychotherapeutic path and on issues that can limit or ease the treatment in forensic residential context.Questa ricerca raccoglie l'esperienza degli psicologi delle strutture forensi di Castiglione Delle Stiviere, nel trattamento psicoterapico di donne figlicide sottoposte a misura di sicurezza. A tal fine è stata somministrata un'apposita intervista ai professionisti che si sono susseguiti nei trattamenti dei casi dal 1999 al 2019. L'analisi dei dati ha permesso di identificare i fattori comuni dell'assunzione in cura psicoterapeutica, così identificati: – la creazione della relazione;– la valutazione dello status psichico e dell’organizzazione della personalità;– la condivisione di obiettivi;– l’elaborazione del fatto-reato;– il lavoro con la rete esterna;– l’accompagnamento alla dimissione.Sono emersi riscontri concordi anche sul ruolo con cui l’opinione pubblica può influenzare il percorso psicoterapico e sugli aspetti facilitanti o limitanti il trattamento, dati dal contesto residenziale forense

Sex offenders dichiarati non imputabili per infermità mentale: caratteristiche cliniche e legali

Sexual offenders constitute a diversified group with mixed specifics, motive and criminal acts. Significant evidences in research suggest that these offenders suffer from large proportions of psychiatric disorders, along with psychotic disorders, mood disorders, paraphilic disorders and Substance Use Disorders. It has been recently ascertained considerable percentages of personality disorders among sex offenders as well: borderline/narcisistic/antisocial. This is a cross-sectional study in which we included all the patients admitted in the 8 REMSs in Castiglione delle Stiviere from January 2009 to December 2018 sentenced for sexual offenses. The result of this study is that most of individuals found NGRI for a sexual offense have a psychotic disorder as a primary diagnosis. The majority of our sample was known by the local mental health services, even if the proportion of whom were not known was high.I sex offender rappresentano un gruppo eterogeneo di autori di reato con motivazioni varie. Le evidenze scientifiche suggeriscono che questi autori di reato, in larga parte sono affetti da disturbi mentali. Fra di essi disturbi psicotici, disturbi dell’umore, disturbi parafilici e disturbi da uso di sostanze e, del tutto recentemente, disturbi di personalità, fra cui in particolare, disturbo borderline, narcisitico ed antisociale di personalità. Il presente studio è trasversale: abbiamo incluso tutti i pazienti ammessi nelle 8 REMS di Castiglione delle Stiviere da gennaio 2009 a dicembre 2018 per aver commesso reati sessuali. Lo studio ha dimostrato che la grande maggioranza dei sex offender con vizio totale di mente erano affetti da un disturbo psicotico. Per lo più si trattava di pazienti già noti ai servizi psichiatrici, sebbene fosse alta anche la percentuali di quelli sconosciuti

Protection of Prisoners with Mental Health Disorders in Italy: Lights and Shadows after the Abolition of Judicial Psychiatric Hospitals

In Italy, a person suffering from a mental disorder who commits a crime will be given a custodial security order and serve the period of admission at a Residenza per la esecuzione delle misure di sicurezza (REMS) (Residence for the Execution of Security Measures, hereinafter "REMS"). These institutions have been established recently and though equipped with the necessary safety measures, the focus is on psychiatric therapy. Despite being present on a national scale, access is very limited in terms of capacity. Immediate remedial measures are needed, so much so that the European Court of Human Rights recently condemned Italy for this very reason. This article, through a review of the constitutive principles of these institutions, shows how they have very positive aspects such as the attention to necessary psychotherapy in order to protect the right to health and the real taking charge of the fragility of the subjects; however, it is seen how there are many negative aspects linked above all to the scarce availability of places in these structures. The article provides suggestions on a more comprehensive strategy for facilities for detainees with mental disorders

Forensic mental health in Europe: some key figures

Purpose. While the number of forensic beds and the duration of psychiatric forensic psychiatric treatment have increased in several European Union (EU) states, this is not observed in others. Patient demographics, average lengths of stay and legal frameworks also differ substantially. The lack of basic epidemiological information on forensic patients and of shared indicators on forensic care within Europe is an obstacle to comparative research. The reasons for such variation are not well understood. Methods. Experts from seventeen EU states submitted data on forensic bed prevalence rates, gender distributions and average length of stay in forensic in-patient facilities. Average length of stay and bed prevalence rates were examined for associations with country-level variables including Gross Domestic Product (GDP), expenditure on healthcare, prison population, general psychiatric bed prevalence rates and democracy index scores. Results. The data demonstrated substantial differences between states. Average length of stay was approximately ten times greater in the Netherlands than Slovenia. In England and Wales, 18% of patients were female compared to 5% in Slovenia. There was a 17-fold difference in forensic bed rates per 100,000 between the Netherlands and Spain. Exploratory analyses suggested average length of stay was associated with GDP, expenditure on healthcare and democracy index scores. Conclusion. The data presented in this study represent the most recent overview of key epidemiological data in forensic services across seventeen EU states. However, systematically collected epidemiological data of good quality remain elusive in forensic psychiatry. States need to develop common definitions and recording practices and contribute to a publicly available database of such epidemiological indicators

The impact of the Covid-19 pandemic on new Forensic Psychiatry facilities in Italy

The COVID-19 pandemic undoubtedly tested the organization of these new italian forensic psychiatry facilities whose practices werw not yet fully established, forcing them to ensure patient safety during lockdown amidst the epidemic