Forensic Psychiatry Research Articles

S ONE STRANE LAKANOVOG OGLEDALA: DORIJAN GREJ PROTIV PORTRETA – PSIHOLOŠKI PROFIL JEDNOG (SAMO)UBICE

Even though the theme of narcissism in The Picture of Dorian Gray is not foreign to literary criticism, the substantial part of that research focuses on the intertwining of it with other aspects of the novel. In such light, the criminal undertone of Dorian’s character can get lost and thus be in danger of being justified. This paper aims toward shedding some light on the dark side of a literary criminal, with an important accent on disregarding the eponymous hero’s sexuality, since it plays no significance in the analysis and, in such a manner, removes itself from the hyperproduction of papers centered around it. The methodological basis for this research is primarily found in J. Lacan and his Mirror Stage, as well as in forensic psychology and psychiatry. Taking into account contemporary scientific findings as well as the specific time and place the novel was created, this paper’s goal is to outline a psychological profile of a narcissistic criminal. In that way, the paper explores aspects of psychology and psychiatry in the novel that have been somewhat neglected in the main current of research.

Neuropsychological parameters in male offenders with substance use disorders.

The impact of cognitive functions on treatment outcomes in forensic psychiatric patients with substance use disorders is not well understood. This study investigates whether neuropsychological deficits, such as in attention, executive functions, and social-emotional cognition, are associated with impulsivity and criminal history. 109 male patients with substance use disorders at the Clinic for Forensic Psychiatry in Rostock were screened using inclusion and exclusion criteria, with 30 consenting to participate. The tests included the Cambridge Neuropsychological Test Automated Battery (CANTAB) to assess cognitive functions in the areas of attention, psychomotor speed, social and emotional perception, and executive functions, with a particular focus on decision making, planning and problem solving. The Barratt Impulsiveness Scale (BIS-11) was used to measure impulsiveness. Participants displayed significantly higher impulsivity levels on the BIS-11 compared to the general population and showed marked deficits in attention, psychomotor speed, and executive functions. There was a minimal correlation between impulsivity and cognitive performance, suggesting that impulsivity does not directly predict cognitive impairments. Notably, extensive criminal histories correlated with poorer cognitive performance, particularly in tasks requiring planning and problem-solving. We found mixed support for the hypothesized associations between neuropsychological functions and criminal histories among patients with substance use disorders. While tasks related to planning and sustained attention showed clearer links, broader cognitive functions displayed inconsistent correlations. These findings emphasize the complexity of the relationship between cognitive deficits, impulsivity, and criminal history, highlighting the necessity for tailored assessments and rehabilitation strategies to enhance outcomes. Future research should focus on larger, longitudinal studies to validate these findings and refine therapeutic approaches.

Investigation of self-stigmatization and perceptions towards delinguency in inpatient individuals diagnosed with schizophrenia in high-security forensic psychiatry settings in Turkiye

Investigation of self-stigmatization and perceptions towards delinguency in inpatient individuals diagnosed with schizophrenia in high-security forensic psychiatry settings in Turkiye

Dissimulation in forensic psychiatric evaluations, a case-control study of the Millon Clinical Multiaxial Inventory-III.

The forensic setting can affect a subject's behaviour.Dissimulation is a mechanism of minimization or concealment of a psycho-pathological condition.The MCMI-III can be a useful tool for a forensic psychiatrist or forensic psychologist in assessing dissimulation.

Scientific support for the use of psychiatric knowledge in the investigation of crimes against human life and health

The category of criminal offences against life and health is quite significant. A large number of crimes included in this category are characterised by a high level of social danger, as they encroach on the greatest social value which is life and health of a person. In the investigation of such crimes, it is typical to use specialised knowledge in the fields of forensic psychiatry and psychology in procedural and non-procedural forms. Given that the process of cognition and assimilation of scientific knowledge begins with clarification of the peculiarities of its historical development, the purpose of the article is to clarify the state of scientific development of the issues related to the use of special psychiatric and psychological knowledge in the investigation of crimes against life and health of a person.
 It has been determined that the current state of scientific significance of the use of special psychiatric and psychological knowledge in the investigation of crimes against human life and health is influenced by the peculiarities of development of criminal procedure legislation. In addition, based on the analysis of legal literature, the assessment of the developments made by Ukrainian scholars has been provided. It is established that careful attention has been paid to the study of certain aspects of the appointment of forensic psychiatric and forensic psychological examinations in the investigation of various types of murders, bodily injuries, and domestic violence. At the same time, based on the results of the generalisation of scientific works authored by Ukrainian scholars, it has been determined that the national legal literature does not address the peculiarities of involving specialists in investigative (search) actions in the course of investigation of crimes against life and health of a person, as well as the prospects for implementing non-procedural forms of using specialised knowledge. The article emphasizes that this issue, as well as the prospects for using specialised knowledge of psychology and psychiatry in non-procedural forms, require a thorough analysis and coverage in the legal literature in order to improve the practical activities of the prosecution in criminal proceedings.

Mental Illness and Parricide. A Case Report of Patricide

According to world-wide statistics, schizophrenia is the most common mental illness identified in people who commit this type of murder. Also, there are slight associations between matricide which is often committed by the sons and patricide which is often committed by daughters. Most of the perpetrators in cases of parricide are under the age of 30, with adolescents covering a big part of the chart. The age of schizophrenic debut, the psychiatric and social attendance of the patients, the active psychotic symptoms, with hallucinations and paranoid persecution ideas but also, the affective inversion towards close friends and family members are frequently found in people who commit parricide. Also, psychotic symptoms and schizophrenia-like clinical aspects can appear in other mental disorders such as mental retardation, dementia or bipolar disorder. The subject is extremely complex as it has to be understood through the characteristics of the mental illness, the basic family relations, the personality of the victims, and last, but not least, the discernment issue that gives more heaviness to the juridical and social involvements of these cases. We hereby present the case of a 17-year-old girl, from the forensic psychiatric board, diagnosed with mental retardation and psychotic symptoms that murdered her father by multiple strikes in vital areas with blunt and sharp objects. We will assess the familial, social and psychological aspects of the case, revealing the implications of mental illness and forensic psychiatry in law enforcement and social services.

Raisonnement médico-légal dans la détermination de l’incapacité totale de travail : une étude qualitative à l’unité médico-judiciaire de l’Hôtel-Dieu de Paris

ObjectivesIn French forensic medical units, medical doctors are requested to assess the functional impact of violence on its victims and to determine a total incapacity for work (ITT). Specific to French criminal law, with significant consequences in the judicial field, this practice is highly heterogeneous with considerable differences depending on the center and the assessor. The objective of this qualitative study was to describe the assessment methods of practitioners in the forensic medical unit at the Hôtel-Dieu Hospital in Paris, where both forensic practitioners and psychiatrists contribute to the evaluation of total incapacity for work. Materials and methodsSemi-structured individual interviews were conducted with four forensic medical practitioners and four psychiatrists. The questionnaire addressed the evaluation methods and tools, the impact of the kinds of violence and their possible chronicity, as well as the rationale for a dual-evaluation by both a forensic practitioner and a psychiatrist. ResultsIn the absence of consensual tools, practitioners tend to take into account the judicial consequences of their assessment of total incapacity for work, while striving to establish an internal coherence between a fact, an injury and its functional repercussions. The osteoarticular system is given as a model, with determined durations of bone healing, while the field of psychotraumatology lacks a similar data set and requires the practitioners to aim to relate the traumatic impact on the daily consequences reported by patients. Forensic practitioners and psychiatrists differ in the extent to which they take into account the plaintiffs’ grievances and the assessment of chronic violence cases. The former tend to determine an incapacity for work based on a clinical lesion, either assessed during their own clinical exam or reported in a former medical certificate, while the latter establish an incapacity for work grounded in the functional consequences reported by patients, especially in cases of psychotraumatic symptoms (sleep disorders, avoidance symptoms, and social interaction limitations, for example) following a physical or sexual assault. A dual-assessment is seen as an efficient way to ensure that the psychological impact of violence is taken into account. However the question arises of the systematic recourse to a psychiatrist or another professional trained in the field of psychotraumatology. The assessment and the clinical symptoms are specific and require appropriate training. Medical certificates are also considered to be judicial material with a broader implication than the sole determination of total incapacity for work. In reporting griefs and the circumstances of the events which have an impact on the clinical situation of the patient, the practitioners also provide qualitative data that a judge may take into account. ConclusionsThis exploratory study describes certain methodological principles used by forensic practitioners and psychiatrists and the inter-specialty variability in the determination of total incapacity for work. It reflects a common expectation for consensual practices based on non-binding indicators. In civil expertise, tools and methodological principals are delineated and discussed, with scales and psychometric instruments which could usefully be relayed to practitioners in forensic medical units dealing with the evaluation of total incapacity for work, a notion that remains specific to French criminal law and whose evaluation standards may also be discussed with practitioners in the judicial field.

What happens after forensic psychiatric care? A latent class analysis of dimensions of welfare for former forensic psychiatric patients

BackgroundMentally disordered offenders are a heterogenous group regarding psychopathology as well as background factors, which makes it likely that more than one stereotypical life situation will apply to all forensic psychiatric patients following discharge. Knowledge about typical life situations would be valuable for optimising support for improving the overall life situation of these individuals. This paper investigates life situations from the perspective of level of living research and resources in terms of different welfare dimensions.MethodsIncluded were all all individuals (n = 1146) who had been discharged from forensic psychiatric care in Sweden during 2009–2018 and were included in the Swedish National Forensic Psychiatric Register. Follow-up time varied from 4 to 3644 days, (m = 1697, Md = 1685). Register data from several different registers was combined. Data was analysed using latent class analysis, and multinominal logistic regression analysis investigated what background factors were associated with class membership.ResultsThe results show that there are four subgroups of post-discharge life situations: the high support group, the general psychiatric needs group, the working group, and the family group. The high support group was the largest, representing 54% of the entire sample. There are background factors associated with group membership, including both age at discharge, length of stay in forensic psychiatric care and pre-index crime historical factors.ConclusionsThis study contributes to the understanding of the post-discharge lives of former forensic psychiatric patients and shows that for several subgroups, negative outcomes are rare. Knowledge about these subgroups could be drawn upon to make informed decisions about in- and outpatient forensic psychiatric care, discharge from forensic psychiatric services, and what support is offered to former forensic psychiatric patients.

Virtual reality-assisted assessment of paranoid ideation in forensic psychiatric inpatients: A mixed-methods pilot study.

Reliable and valid assessment of paranoia is important in forensic psychiatry for providing adequate care. VR technology may add to current assessment procedures, as it enables observation within realistic (social) situations resembling the complexity of everyday life. VR constitutes a promising tool within forensics, due to the restricted nature of forensic psychiatric hospitals and ethical challenges arising from observing potentially dangerous behaviors in real life. To investigate the feasibility of VR assessment for paranoid ideation in forensic psychiatric inpatients qualitatively by assessing the experiences of patients and a clinician, and to explore how the VR measures relate to established clinical measures. One clinician (experienced psychiatrist) and 10 forensic psychiatric inpatients with a history or suspicion of paranoid ideation were included. Patients participated in two immersive VR scenarios (bus and supermarket) during which paranoia was assessed by the clinician. Qualitative interviews were performed with patients and the clinician performing the assessment to investigate experiences and feasibility. Further, measures of paranoia, social anxiety, and positive symptoms were obtained. Nine out of 10 participants with varying levels of paranoid ideation completed the assessment. Manifest inductive content analyses of the interviews revealed general experiences, advantages such as enabling observing participants from a different perspective, and challenges of the VR assessment, such as a lack of objectivity and the laboriousness of the assessment for the clinician. Although more paranoia was experienced during the supermarket scenario, correlates with classical measures were only significant for the bus scenario. The VR assessment was appreciated by most patients and the clinician. Based on our results short, standardized VR assessment scenarios are feasible, however, they do not appear reliable or objective for assessing paranoia. The clinical usefulness is most likely as a collaborative tool and add-on measure to existing methods.

Mild Behavioral Impairment

Abstract: Socially inappropriate behavior accompanies and modulates delinquency across the lifespan. In contrast to young people, the emergence of such traits among older individuals could indicate incipient neurodegenerative disease. Before developing a neurocognitive disorder, subtle behavioral changes may reflect a disintegration of neural networks involved in impulse control or social cognition. Whereas psychiatric evaluation often considers a comprehensive cognitive assessment, unremarkable results may discourage clinicians from recognizing brain disease underlying behavioral disturbance. We first provide an overview of its manifestations and neural correlates and the interrelations with mild cognitive impairment (MCI) before demonstrating how to investigate and diagnose mild behavioral impairment (MBI). Finally, we show how to appreciate MBI in geriatric forensic psychiatry.

Reducing Risk for Future Violence From Forensic Psychiatric Patients by Using Critical Factors of the Short-Term Assessment of Risk and Treatability as a Caring Tool.

The dual task for forensic mental health care is community protection and treatment of mental disorders. The Short-Term Assessment of Risk and Treatability (START) has become an established tool for risk assessment and care planning in forensic psychiatry. When using the START, items judged as critical factors are chosen to be addressed in the care plan. However, it is not known which critical factors that are of special interest need to be addressed to reduce the risk for future violence. The main aim of this study was to explore how staff's choice of critical factors in the care planning influences risk for future violence. The study is based on 787 START assessments from 285 convicted and involuntary admitted inpatients at the Forensic Psychiatric Clinic of Stockholm County, Sweden. The influence on risk for future violence by selecting a certain item as a critical factor in the care plan was measured by comparing patients' sum of vulnerabilities at the time this certain critical factor was selected with this sum at the next assessment. The results show that a patient's overall risk for future violence decreases significantly when the items "insight," "attitudes," "mental state," "coping," and "drug use" were addressed as critical factors in the care planning. The importance of specified critical factors differs between diagnostic groups and time after admission. When staff select certain specified items as critical factors in the care planning, the patients' risk of relapse into acts of violence was significantly reduced.

Case report: The Circle Game

The authors present a rare case of a family in which both the mother, and four decades later the son, committed second-degree murder while suffering from major mental illnesses. The mother had successfully used a mental disorder defence and it was likely that the son who had raised the defence would have qualified also. The mother has a history of adverse childhood experiences. The son had also experienced various severe childhood adversities, though there were no functional impairments, personality dysfunction, suicidality or violent crimes until the onset of treatment-resistant schizoaffective disorder around age 18. His earlier comorbidities included sport-related traumatic brain injuries, sickle cell trait, severe burns, and tardive dyskinesia. His comorbidities around the material time included occasional cannabis use and dementia pugilistica. While awaiting court ruling on criminal responsibility, additional stressors triggered significant deterioration of his schizoaffective disorder and the court found him unfit to stand trial. During rehabilitation, he was severely injured by another accused, which subsequently led to his demise. This case is the first report of intergenerational mental disorder defence and involved almost every facet of criminal forensic psychiatry, which highlights the need for further research on the association between intergenerational ACEs and intergenerational risk for criminal behaviour from a comprehensive and longitudinal perspective.

Drug-facilitated sexual assault followed by femicidal chloroform poisoning and suffocation: A case-report of criminal responsibility

IntroductionCriminal responsibility evaluation represents one of the most controversial and debated issues in forensic psychiatry. Although clear procedures have been recommended, little research exists on decision-making process by forensic psychiatrists. We present a case assessing the criminal responsibility of a murderer who committed femicide as a result of chloroform poisoning and suffocation after a drug-facilitated sexual assault. Materials and methodsA.S., a 30-year-old female, was found dead in the home of S.P., a 50-year-old male. S.P. recounted killing A.S. by forced inhalation of chloroform, when the woman had experienced sensory clouding following unintentional ingestion of Zolpidem, a hypnotic agent. A multidisciplinary approach was taken to resolve the case. Autopsy, histological, genetic, and toxicological examinations were performed by a forensic pathologist, while a digital forensic examiner analysed electronic devices. A pool of three forensic psychiatrists and two psychologists was asked to assess the mental state of S.P. at the time of the crime. Results and conclusionsThe cause of death of A.S. was identified as a lethal chloroform intoxication in altered consciousness caused by Zolpidem, while homicidal suffocation was also described. Mobile forensics demonstrated that S.P. had videotaped the crime scene, clearly revealing that A.S. had been sexually assaulted by S.P. before dying. Criminal responsibility of S.P. was evaluated through various psychological tests and seven interviews with the accused, each lasting an average of 180 min. Specialists concluded that S.P. could not be exempted from being responsible for the homicide.

La formation des professionnels en psychiatrie légale : résultats d’une enquête en Occitanie

ObjectivesSince the enactment of the French law of 4 March 2002, patients’ rights have been the subject of constant legislative evolution and particular attention from many independent administrative authorities. In psychiatry, these have led to numerous legal reforms over the years. Moreover, psychiatry is a medical specialty with abundant, long-standing and more than ever topical interactions with the judicial system (psychiatric care without consent, isolation and restraint, court-ordered care, psychiatric care in prisons, treatment of perpetrators of sexual violence, judicial expertise or the question of lack of criminal responsibility due to a mental disorder). In response to the many legal questions asked by medical and paramedical teams, and to the growing interest in research in forensic psychiatry, a unit called EPL (Espace de Psychiatrie Légale) was created, composed of a multidisciplinary team, based in the department of Haute-Garonne, France. In order to adjust its scope of intervention, a questionnaire was distributed to mental health professionals to assess their training needs in forensic psychiatry. In this article, we aim to present and discuss the results of this survey. MethodsWe used a self-assessment survey designed by the multidisciplinary team of the EPL and which was filled out online by the respondents. The target population was all the professionals working in mental health facilities, members of the FERREPSY Occitanie research federation. The questionnaire consisted of several sections relating to the respondents, the typology of patients under their care, the professionals’ daily practice, and training in and knowledge of forensic psychiatry. We included some open-ended questions on the situations encountered that may have presented difficulties and on the impact of legislative changes on the daily practice of professionals. All responses were analyzed anonymously. ResultsFrom 05/05/21 to 17/07/21, 155 professionals responded. Most of them were psychiatrists (32.3%), healthcare managers (20.6%) or nurses (18.7%). The majority were women (78.7%) and had been working in Haute-Garonne for more than 5 years (74.2%). 56.1% of the professionals worked in outpatient units, 37.4% in inpatient wards and 74.8% in adult psychiatry. This questionnaire revealed a strong need for training in forensic psychiatry. Indeed, 94.8% of respondents wanted to receive training in forensic psychiatry, which contrasts with the number of people who had already received training in this area (15.5% in initial training, 32.3% in continuing education). The results highlighted that the most common forensic situations encountered in daily clinical practice concerned areas where professionals considered their knowledge to be insufficient. In addition, the self-assessment scales used were able to highlight specific training topics that should be developed. ConclusionsThe results of this survey therefore establish a basis for making adjustments to future educational interventions involving forensic psychiatry, which, although it has only recently emerged in France, embraces issues that have always concerned the management of patients receiving psychiatric care.

Excellence in forensic psychiatry services: international survey of qualities and correlates.

Excellence is that quality that drives continuously improving outcomes for patients. Excellence must be measurable. We set out to measure excellence in forensic mental health services according to four levels of organisation and complexity (basic, standard, progressive and excellent) across seven domains: values and rights; clinical organisation; consistency; timescale; specialisation; routine outcome measures; research and development. To validate the psychometric properties of a measurement scale to test which objective features of forensic services might relate to excellence: for example, university linkages, service size and integrated patient pathways across levels of therapeutic security. A survey instrument was devised by a modified Delphi process. Forensic leads, either clinical or academic, in 48 forensic services across 5 jurisdictions completed the questionnaire. Regression analysis found that the number of security levels, linked patient pathways, number of in-patient teams and joint university appointments predicted total excellence score. Larger services organised according to stratified therapeutic security and with strong university and research links scored higher on this measure of excellence. A weakness is that these were self-ratings. Reliability could be improved with peer review and with objective measures such as quality and quantity of research output. For the future, studies are needed of the determinants of other objective measures of better outcomes for patients, including shorter lengths of stay, reduced recidivism and readmission, and improved physical and mental health and quality of life.

A critical review of undergraduate education and teaching in forensic psychiatry.

Although forensic psychiatry is recognised as a full medical speciality in the UK, training in it is not routinely offered to medical students. With growth both in forensic psychiatry and availability of medical school places, it is a good time to explore the nature and quality of experience already available. 1. To map the literature against the guideline for reporting evidence-based practice educational interventions and teaching checklist. 2. To critically review research and scholarship. 3. To identify gaps in evidence-based education for medical students in forensic psychiatry. A systematic search of three bibliographic databases from inception to December 2021 was undertaken using keywords related to medical students and forensic psychiatry between December 2021 and March 2022. The search was supplemented by citation and hand searching. Eight articles were identified. Collectively, they suggest that education and teaching were implemented at a local level and not linked to theories of learning. Exposure to forensic psychiatry stimulated positive attitudes, which amplified interest in psychiatry. There was insufficient evidence to determine optimal undergraduate education and teaching practice in forensic psychiatry. Forensic psychiatry appears to have much to offer the medical undergraduate as part of core learning in psychiatry, including universal skills and knowledge such as ethical decision-making and handling emotions. There appears to be considerable opportunity for education, teaching and research innovation in undergraduate education and teaching in forensic psychiatry. Interesting areas for development include simulated and coproduced education.

Violent behaviour in adolescents: assessment and formulation using a structured risk assessment tool

SUMMARYTeenagers often present in crisis with risk issues, mainly risk to self but sometimes risk to others. Adolescent violence is commonplace and is not just the remit of adolescent forensic psychiatry. Clinicians may lack confidence assessing risk of violence and can neglect vital areas that are essential to reduce risk. Use of structured violence risk assessments enables the multi-agency professional network to formulate a young person's presentation and their violence in a holistic way and consequently develop targeted risk management plans addressing areas such as supervision, interventions and case management to reduce the risk of future violence. Of the several validated tools developed for young people, the Structured Assessment of Violence Risk – Youth (SAVRY™) is that most used by UK-based forensic adolescent clinicians. This article outlines the epidemiology, causes and purposes of violence among adolescents; discusses types of risk assessment tool; explores and deconstructs the SAVRY; and presents a fictitious risk formulation.

Court-ordered inpatient psychiatric care in Switzerland: determinants of length of stay and treatment outcome.

IntroductionIn several European countries, offenders with decreased or abolished responsibility and high risk of recidivism due to long-lasting mental disorders are compulsory admitted for court-ordered treatments (COT) that take place in high and medium-security hospitals. As a rule, length of stay in these structures is very long implying major restrictions for the inmate and high societal cost. Despite intensive research, the predictors of length of stay and treatment outcome in long stay forensic services is still matter of debate.MethodsWe report here a detailed analysis of the demographic, psychiatric and offense predictors of length of stay and discharge locations of 204 mentally disordered offenders convicted to COT in a new medium-security forensic psychiatry clinic in Geneva, Switzerland. Kaplan-Meier survival estimates were performed to determine time to release. Length of stay was predicted by Cox regressions, and discharge locations were predicted by multinomial logistic regressions.ResultsThe typical inpatient was a 35-age single male re-offender, submitted to COT after a conviction for physical violence (78.9%) or property violation (64.2%), with drug trafficking (52.9%), in relation to psychotic (67.2%), antisocial or borderline personality disorder (35.8%) with comorbid substance use disorders (60.3%). Sex offenses were found in 24.5% of cases and were associated with Cluster B personality disorders. The median length of stay was of 2.5 years and was independent of demographic variables, severity of crime recidivism and psychiatric diagnosis. Longer COT at admission, and type of offense (in particular drug traffic and sexual violence) predicted longer stays. At discharge, 32.8% of cases were transferred to sheltered educational housing, 23.1% to open low-security wards, while 30.6% returned to regular prisons and 9.7% to their country of origin.DiscussionYounger age and conviction for property violation rather than physical violence increased the chances to be discharged to sheltered educational housing. Longer COT at admission, personality disorders, and conviction for sexual offense increased the risk to return to prison. These data suggest that sex offenses determine not only longer stays under COT but also drastically decreases the chance of freedom for inmates with Cluster B personality disorders.

The roles of Klotho and FGF-23 in bipolar manic episode.

Bipolar disorder (manic episode) is an essential psychiatric disorder with unknown etiology, in which inflammation is considered to play a role. Klotho and FGF-23 are known to be associated with inflammation. Therefore, this study aimed to determine the link between Klotho and FGF-23 levels and bipolar disorder. In this study, 42 men with BD and 41 healthy controls were enrolled, followed up, and/or treated at the High-Security Forensic Psychiatry Clinic. Sociodemographic data form, Young Mania Rating Scale, and Hamilton Depression Rating Scale were applied to all participants. Klotho and FGF-23 levels were significantly increased in patients with BD manic episodes. There was no correlation between Klotho and FGF-23 levels and clinical parameters. For Klotho and FGF-23, cutoff values of 69 and 1,646 yielded 67.4% sensitivity and 72.1% specificity and 81.4% sensitivity and 51.2% specificity, respectively. Klotho and FGF-23 may play critical roles in the etiopathology of manic episodes and are potential candidate biomarkers for bipolar disorder. This relationship might contribute to the etiopathogenesis of the disease and determine its treatment. Anti-Klotho and anti-FGF-23 administration may be a future treatment for controlling the course of the disease.

Canadian Guidelines for Forensic Psychiatry Assessments and Report Writing—Executive Summary

Canadian Guidelines for Forensic Psychiatry Assessments and Report Writing—Executive Summary