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

Delirium in COVID patients: recommendations for assessment and treatment

COVID-19 patients, particularly those admitted to an Intensive Care Unit, are at high risk of Delirium due to the frequently observed concomitant presence of a series of factors which, taken together, constitute an increased risk factor. Factors thought to play a key role include: a direct action of the virus and state of inflammation on the Central Nervous System; secondary effects of organ failure; effect of sedative treatment; prolonged exposure to mechanical ventilation; prolonged immobilisation; environmental factors including social isolation and restricted interaction with relatives and healthcare operators. Bearing in mind the potential impact of delirium on clinical outcome, with an increased risk of death, appropriate prevention and management of this condition, particularly complex in COVID patients due to the frequently observed concomitant presence of numerous predisposing and precipitating factors, is fundamental

Uncertainty in Pandemic Times

The Covid-19 pandemic has burst upon us as a general test for humanity, for which we were woefully unprepared. We all faced the pandemic with little knowledge and no experience. It is the first pandemic of our lives. Over this period, we have seen a range of conflicting statements, positions and behaviours. On occasion, the scientific community and health professionals have failed to speak with a single voice to convey the urgency of the situation, as their views got lost and scattered in rivulets of opposing theories ranging from denying to ringing the alarm. So many elements were in place for the ‘perfect storm’ to get unleashed … and it did. And as the pandemic wreaked its havoc, many health workers have paid a high price for their selfless dedication and professionalism. We have worked in the absence of clear-cut guidelines, in situations where even the cornerstones of medical ethics have faltered. On the other hand, the fruitful aspects of uncertainty also emerged

The New Challenges for Medical Ethics

The evolution of medicine confronts healthcare professionals with new ethical challenges. Elements such as professional secrecy, patient benefit, justice in the distribution of resources are put in crisis by the evolution of medical procedures. Today, doctors must make life-and-death decisions about many patients. As the resources are not enough for all patients, the ‘first-come, first-served’ criterion crumbles under the weight of the overwhelming demand for treatment. Consequently, they can no longer make treatment decisions based only on proportionality and clinical appropriateness criteria. They must take into account the availability of resources and prioritise patients with ‘the longer life expectancy’. This amounts to saying ‘the weakest will die’ … with the doctors’ consent. While the guidelines issued by scientific societies may well protect doctors from lawsuits, the choice of who to treat and who to let die is left to the conscience of the individual doctor; and it is a choice sharply clashing with the Hippocratic oath and with professional and personal ethics. This and others are a real ethical problem

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

Self-Assessed Personality Traits and Adherence to the COVID-19 Lockdown

Introduction: The COVID-19 pandemic, caused by the SARS-CoV-2 coronavirus, has forced all countries affected by it to introduce quarantine and isolation to prevent the spread of the virus, as well as masking and distancing. Not everyone is equally willing to follow the rules related to limit the extent of the coronavirus epidemic. This might be connected with personality traits, especially openness, positive attitude, and optimism. Materials and Methods: An online survey was created and completed by participants in April–May 2020. Self-assessment of personality traits and adherence to lockdown recommendations were assessed. A total of 7404 participants took part in the study, mainly from Poland (83.6%) and Italy (12.7%). Univariate and multivariate regression analysis was performed. Results: The participants were divided into groups depending on the degree of compliance with the lockdown rules. In the multivariate analysis, variables that increased the odds for stricter lockdown compliance were temporary work suspension OR 1.27 (95% CI 1.10–1.48), income level “we can’t handle this situation” OR 1.67 (95%CI 1.20–2.33), and junior high school education OR 1.68 (95% CI 1.13–2.50). Other significant factors included age and place of residence. Each point of self-assessed sociability OR 1.07 (95% CI 1.00–1.13) also increased the likelihood of adhering to lockdown rules. Conclusions: Taking the basic demographic characteristics as well as working and health environment conditions traits into account may be helpful when forecasting epidemiological compliance during a pandemic, as well as in other public health tasks. The key role of self-assessed personality traits was not confirmed in this study. Reliability of the results is limited by significant disproportions in the size of the study groups

Validity and reliability of the Structured Clinical Interview for the Trauma and Loss Spectrum (SCI-TALS)

Background. DSM-IV identifies three stress response disorders (acute stress Disorder (ASD), post-traumatic stress Disorder (PTSD) and adjustment disorders (AD)) that derive from specific life events. An additional condition of complicated grief (CG), well described in the literature, is triggered by bereavement. This paper reports on the reliability and validity of the Structured Clinical Interview for Trauma and Loss Spectrum (SCI-TALS) developed to assess the spectrum of stress response. The instrument is based on a spectrum model that emphasizes soft signs, low-grade symptoms, subthreshold syndromes, as well as temperamental and personality traits comprising clinical and subsyndromal manifestations. Methods. Study participants, enrolled at 6 Italian Departments of Psychiatry located at six sites, included consecutive patients with PTSD, 44 with CG and a comparative group of 48 unselected controls. Results. We showed good reliability and validity of the SCI-TALS. Domain scores were significantly higher in participants with PTSD or CG compared to controls. There were high correlations between specific SCI-TALS domains and corresponding scores on established measures of similar constructs. Participants endorsing grief and loss events reported similar scores on all instruments, except those with CG who scored significantly higher on the domain of grief reactions. Conclusion. These findings provide strong support for the internal consistency, the discriminant validity and the reliability of the SCI-TALS. These results also support the existence of a specific grief-related condition and the proposal that different forms of stress response have similar manifestations

La Pericolosità sociale psichiatrica tra attualità e criticità = Social dangerousness of mentally ill patients: current approach and dilemmas

L’evoluzione della legislazione in tema di assistenza psichiatrica a partire dal 1978 non è stata accompagnata da una parallela trasformazione dell’interfaccia giuridica; la posizione del malato di mente autore di reato considerato incapace di intendere e volere continua ad essere sottoposta al giudizio di pericolosità sociale psichiatrica con le conseguenti misure di sicurezza, su cui si regge l’esistenza dell’Ospedale Psichiatrico Giudiziario. In questa prospettiva il trattamento del paziente psichiatrico autore di reato si configura come estremamente complesso e gravato dalla irrisolta antinomia cura/custodia. Tuttavia l’abolizione della presunzione di pericolosità ha modulato l’applicazione stessa delle misure di sicurezza verso assetti più terapeutici. Le criticità di percorso riguardano la valutazione della pericolosità sociale, la individuazione di luoghi di trattamento appropriati, la opportunità di interventi mirati al comportamento violento e non ultimo il profilo di responsabilità dello psichiatra

A \u201cpithecoid feature\u201d in skulls confirming possible neuro-psychiatric disorders. The diagnoses of an anthropologist of the nineteenth century

Background and aim: The interest for the morphological research of degenerative signs aimed at identifying personality pathologies characterized positive anthropology of the late nineteenth century. The increasing exploitation of statistical-epidemiological methodologies together with the recent neuroscientific acquisitions, risk dangerous effects on mono-factorial models on the understanding of antisocial behavior. Methods: Through historical analysis of the research carried out by the positivist anthropologist Giuffrida Ruggeri on the lack of the glenoid dimple of the temporal of the alienated, the authors examine the criticality of rigid and one-way psychopathological interpretative approaches also in relation to recent applications of neuroscience. Results: Increasingly, the scientific approach seems to abandon an interpretative vision anchored to rigid biological and statistical parameters to embrace a dimension adequate to the singularity and complexity of man. In this approach, neurosciences contribute to supporting the circularity of the interpretative model of antisocial behavior. Conclusion: Far from a deterministic return that assigns a decisive role to constitutional factors, new knowledge leads us to reflect on mutual, continuous and harbingers of biology and the environment in the characterization of the human being, in a constructive dialogue with ethics

Clinical case 1: The dark Side of Mother A Clinical case in Italy

Maternal filicide -- the killing of a child by the mother -- is not a new phenomenon. Evidence of mothers killing their infant's dates back to at least 2000 b.c.e. and the ancient Chaldean civilization. When a mother kills her children, it breaks a cardinal rule that violates the natural course of life -- that is, the maternal instinct to safeguard the survival of her young. Andrea Yates captured public attention when she drowned her five children in 2001. Initially met with public shock and outrage, the Yates case also spotlighted postpartum psychosis and the intersection of maternal mental illness and the criminal justice system. Coedited by George Parnham, the attorney who successfully defended Yates, this book includes his narrative account of how he first heard about the case and was ultimately hired to represent her. It also features more than 30 experts in the field representing eight countries and provides real case examples. In addition, the book includes a chapter on paternal filicide, an important subject that receives far too little attention in the literature. Firmly rooted in research, thorough in its description of theory, and packed with practical applications, this collection highlights the necessary competency areas for those involved in maternal mental health forensics, whether psychologists, psychiatrists, social workers, or lawyers. The book is organized along the four foundations of maternal mental health forensics: The legal aspects surrounding maternal infanticide and filicide The impact of perinatal psychiatric complications in maternal filicide The role of the expert witness in infanticide and filicide cases Sociocultural considerations and feminist approaches to prevention and treatment Each chapter culminates in a summary of main clinical/legal and cultural points and a section of practice questions and discussion prompts. A glossary at the end of the book provides key terms and concepts. Useful as an educational and training resource for those involved in maternal infanticide and filicide cases -- either on the defense or prosecution -- or those simply interested in the field, this guide offers a comprehensive understanding of the legal outcomes, greater understanding of the multiple motivations for these crimes, their potential psychiatric underpinnings, the social and global contexts, and advanced understanding from a biopsychosocial perspective. This volume also illuminates the consequences of untreated or poorly treated perinatal mental illness and further establishes maternal mental health forensics as a subspecialty field in its own right, even as it acknowledges differences in opinion, theory, and conceptualizations. In doing so, this book serves as an important and necessary step toward canonizing the field of maternal mental health forensics and continued understanding beyond filicide and infanticide -- which involves child custody disputes, other homicide cases, assault charges, criminal negligence causing bodily harm, and other offenses in which maternal mental disturbance may have played a key role