Forensic Psychiatry Research Articles (Page 1)

Psychosocial maturity is one of the key factors for understanding the course of criminal offences in juveniles and young adults. Until recently, forensic-psychiatric assessments to diagnose a severe disorder of personality development remained mostly unguided because validated instruments were not available. A new tool, the Young Adult Personality Development (YAPD) instrument, was introduced in 2021 and consists of three dimensions related to psychosocial maturity:YAPD environmental,YAPD pathologyandYAPD developmental tasks failure. The current study tested the reliability (internal consistency, interrater reliability) and concurrent validity of these dimensions. We analysed files of a consecutive sample of young adults in the Canton of Zurich (2007 to 2020, n = 234, mean age: 21.33 years, SD: 1.74 years), who were either assigned to specialised institutional treatment for young adults (Swiss Penal Code [SPC] Article 61) or outpatient treatment (SPC Article 63). Intraclass correlation coefficient (ICC) agreements were used to analyse interrater reliability of YAPD dimensions across three independent raters. In the absence of a gold standard, we analysed concurrent validity by measuring the associations of the YAPD dimensions with expert opinion and sample status (judicial decisions on measures) using multiple logistic regressions. Expert-rated personality development disorder was found to be highly prevalent in both samples. The YAPD dimensions showed adequate-to-good interrater reliability (ICC: 0.74-0.92). In logistic regression models,YAPD developmental tasks failurewas related to diagnoses of severe development disorder and juridical decision on a measure for young adults according to SPC Art. 61.YAPD environmentalwas related to the diagnosis of a severe development disorder.YAPD pathologywas found to be unrelated to the diagnosis of severe personality development disorder. Our findings support theYAPD developmental tasks failuredimension and to a lesser degree theYAPD environmentaldimension as valid dimensions to diagnose severe personality development disorder. Structured assessment instruments such as the YAPD may further improve diagnostic decision-making in forensic psychiatry and psychology.

Background/Objectives: The Commission d’examen des troubles mentaux (CETM), under Quebec’s Tribunal Administratif du Québec, reviews individuals found not criminally responsible on account of mental disorder (NCRMD). These hearings seek to balance public safety with reintegration, guided largely by treatment team recommendations. Despite the CETM’s central role in forensic psychiatry, limited empirical data exist on how its decisions align with clinical advice and which dynamic risk factors influence outcomes. This study aimed to (1) profile the CETM’s 2023 caseload, (2) evaluate concordance between CETM dispositions and treatment team recommendations, and (3) examine clinical, social, and legal factors associated with decision-making. Methods: We conducted a retrospective review of 1721 judgments issued by the CETM in 2023, retrieved from the publicly accessible Société Québécoise d’information juridique (SOQUIJ) database. Eligible cases included annual NCRMD review hearings, excluding trial fitness assessments and repeated hearings within the same year. A structured coding grid documented sociodemographic, administrative, legal, and clinical information, with emphasis on dynamic risk factors such as treatment adherence, substance use, and recent aggression. Descriptive analyses summarized population characteristics and concordance between clinical recommendations and CETM decisions. Results: The cohort was predominantly male (85%) with a mean age of 41 years. Psychotic disorders were the most frequent primary diagnoses (76%), frequently accompanied by substance use and antisocial traits. Most patients (79.6%) had prior psychiatric hospitalizations, while 25.5% had prior incarcerations. Nearly half displayed recent aggression or non-compliance. Treatment teams most often recommended conditional discharge (55%), followed by detention with conditions (21%) and unconditional release (19%). CETM decisions aligned with recommendations in 83.6% of cases; when divergent, rulings were more restrictive (8.6%) than permissive (4.6%). Conclusions: This study provides the first large-scale profile of Quebec’s CETM. High concordance with clinical teams was observed, but restrictive decisions were more frequent in cases of disagreement. The findings underscore the importance of incorporating standardized risk assessment tools to enhance transparency, consistency, and balance in forensic decision-making.

ABSTRACT This study explores growth trajectories of risk factors among patients in high-security forensic psychiatric settings. Using latent growth curve modeling, changes in Historical Clinical Future-Revised (HKT-R) risk factors were assessed among 471 patients in Flanders, Belgium, over three to four years of treatment. A multi-group approach compared HKT-R trajectories across patient profile, criminal history, and discharge status. Overall, significant reductions were observed in the clinical scale and half of the clinical factors, as well as both future scales and nearly all future factors. As anticipated, patients who successfully completed treatment showed faster improvement than those still admitted, remitted to prison, or who absconded from the FPC. However, no significant differences in trajectories emerged between first offenders and recidivists. Patient profiles ‘psychotic patients with diverse criminal behavior’ and ‘patients with a personality disorder and multiple problems’, groups characterized by fewer physically violent index offences, showed the greatest clinical improvement. Specifically, the former patient group improved more rapidly in clinical factors compared to antisocial patients. In contrast, patients with a paraphilic disorder and sexual crimes showed no significant change. These findings underscore the importance of tailoring treatment approaches to patient subtypes, offering valuable insights for clinical practice and future research.

Purpose To investigate somatic health burden and self-rated health (SRH) among forensic psychiatric (FP) patients and the concordance between these two health measurements. Additionally, the study evaluates how different binary groupings of SRH responses impact concordance. Methods In a cross-sectional study, 67 inpatients from two Danish forensic psychiatric hospitals were assessed. SRH was measured using a single-item question from the validated and widely used SF-12 scale, and clinical evaluation was performed by a general physician using the Clinical Frailty Scale (CFS). SRH responses were dichotomised in two different ways to test concordance with clinical assessment, and detailed somatic health data were collected from consultations with health care professionals and patient records. Results Seventy-nine percent of FP patients assessed their own health as “good” or better despite the presence of risk factors such as history of smoking (median pack years = 20) and 25% having hypertension, 84% being overweight, and 55% having metabolic syndrome when assessed by a physician. We found a total of 195 somatic diagnoses with no clear trend in either diagnosis or organ system. Regardless of grouping, concordance between self-reported health and clinician-rated CFS remained low, ranging from 58 to 61%. Conclusion This study reveals discrepancies between forensic psychiatric patients’ subjective and clinically assessed health. The findings underscore the need to interpret SRH with caution in populations with severe mental illness, where discrepancies between SRH, physician-rated health and diagnoses burden are pronounced. Clinicians and researchers should approach SRH critically to avoid underestimating patients’ health risks.

Clinical recovery of symptoms after administration of long- acting treatment with injectable aripiprazole through recovery of inflammatory processes in parts of the brain and imaging results of brain CT scan of a patient of the field of Forensic Psychiatry with serious traumatic brain injury caused by a gunshot before and after undergoing neurosurgery

BackgroundOffenders who pose a risk of harm and whose convictions are linked to substance use can be mandated to undergo treatment in forensic psychiatric hospitals under Section 64 StGB of the German Penal Code (Strafsgesetzbuch; StGB), if there are reasonable prospects that treatment might be successful. Relapses during treatment is a common occurrence in patients with substance use disorders but little is known about the frequencies of such events in a forensic setting.PurposeThis study aimed to determine the prevalence of relapse among patients who undergo treatment under § 64 StGB, identify substances involved and possible predictive factors.MethodWe utilized data over the span of two years from 108 patients who were admitted to the Clinic of Forensic Psychiatry in Rostock, Germany, between 2019 and 2021.We used descriptive statistics and multiple regression analysis. A relapse was defined as a positive laboratory test for illicit drugs or alcohol, admission of relapsing or a declined test (i. e. the patient did not consent to the test).ResultsWe found that 65.7% of the patients relapsed within the initial two-year period of stay. Cannabinoids were the most commonly consumed substances. Factors such as age, education level, comorbidity, number of previous convictions, duration of stay and type of substance used did not significantly affect relapse rates. Results are limited by a small sample size.ConclusionA high relapse rate is still a reality of forensic addiction treatment. Static factors alone might only have a small predictive value for substance relapses and are not sufficient to fully predict individual risk. Therefore our findings show a need to focus on dynamic factors that affect consumption relapse rates. Considering the findings of this research, future studies should investigate dynamic factors of the patient’s substance use behavior during treatment as a whole (e.g. reason for relapsing, choice of drug etc.), identify and investigate other factors affecting relapse rate and uncover possible treatment interventions that might reduce relapse rates, dropout rates and criminal recidivism.

Artificial intelligence in forensic psychiatry: potential applications and key considerations.

Geriatric Forensic Psychiatry and Oklahoma Bill HB 3505: Human Rights and Advocacy in the Complex World of Capacity Assessment

Introduction: Currently, there is a trend of increasing requests for fit-to-work examinations from several institutions regarding their mental health of employees, which are expected to provide some input for actions or decisions, such as termination due to their mental disorder, temporary permit leave, or other forms of assistance. This phenomenon was observed at Professor Dr. Soerojo Mental Health Hospital, Magelang, and Dr. Cipto Mangunkusumo General Hospital, Jakarta, as two hospitals that represent the work situations of the authors. This study aimed to search for a standardized FFD evaluation to release an accurate and objective forensic psychiatry report and minimize the risk of legal conflict and dispute. Methods: This qualitative systematic review used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) method. The clinical question was formulated with the PICO model, which focuses on the fit-to-work examination procedure from a forensic psychiatry perspective. The search was conducted in PubMed, Scopus, ProQuest, PsycInfo, and Cochrane databases. Results: The search yielded 5 matched articles, which were then analyzed and compared to each other afterwards. The analysis included the steps of the fitness for duty examination procedure and the formulation of opinions based on the examination. Discuss: The stages involved in a psychiatrist's assessment of fitness for work include the examination stage and the formulation of examination results to form an opinion regarding fitness for work to produce an objective forensic psychiatric report. Conclusion: Clinician or forensic psychiatry team must take note of clear and concise examination in forensic psychiatry and give specific recommendations and advice to the referrer if therapy is required, including an explanation of the type and frequency of therapy needed and how recovery will occur. This will help the referrer understand exactly how an individual who is currently unfit for work can become fit for work in the future, as well as explain how symptoms of mental disorders can arise in the work environment and describe the early signs of recurrence.

Background The identification of patients in forensic psychiatric care within national health registries has historically posed significant challenges, limiting research to small-scale studies and restricting its scope. This study aims to evaluate the utility of the Danish National Patient Register (DNPR) for research purposes by assessing the criterion concurrent validity of administrative trajectory markers for identifying incident patients receiving forensic psychiatric care. Methods We employed a population-wide design, analyzing data from the entire Danish population aged 15 years and older (almost 5 million individuals). Incident forensic psychiatric patients between January and December, 2022, were identified through a trajectory start marker in the DNPR. Validity was assessed by comparing these cases to confirmed cases from the Central Criminal Register (CCR). Test statistics, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value, were calculated. Results A total of 323 forensic psychiatric patients were identified in the DNPR, of whom 289 (89.5%) were confirmed as incident cases in the CCR. The sensitivity of any trajectory start marker was .755 (.708–.797), and the PPV was .895 (.856, .926). PPV varied across the five Danish regions and between individual trajectory markers, with the highest PPV (.950) observed among patients sentenced to outpatient psychiatric treatment with the option of hospitalization. Conclusions The findings suggest that trajectory markers are a promising approach for reliably identifying incident forensic psychiatric cases within Danish national health registers. Further studies are needed to confirm their validity across different contexts, informing clinical practice and policy decisions in forensic psychiatry.

Epilepsy in the context of forensic psychiatry: The relationship between epilepsy, violence and criminal responsibility.

Technologies such as virtual reality, wearables, and mobile apps have the potential to improve forensic psychiatric treatment of youths. Meanwhile, these technological advancements have given rise to new, complex ethical challenges. Paying attention to ethics is especially relevant in forensic psychiatric youth settings because of the often coercive context of treatment and the vulnerable patient population. The goal of this viewpoint paper is to identify and discuss important ethical challenges regarding the use of technology in forensic psychiatric youth care. In line with approaches within the domain of ethics, an analysis of relevant scholarly literature was used for this viewpoint paper. First, a general description, an overview of research on effectiveness, and examples from practice are provided for six technologies that can be used in forensic psychiatric youth care: virtual reality, internet-based interventions, mobile apps, wearables, neurotechnology, and games. Next, ethical challenges that are relevant for these technologies are explored, related to informed consent, privacy and data security, reliability and validity, equity, accessibility and usability, undesirable side effects, acceptability of content, persuasiveness, and evidence-based interventions. Interdisciplinary collaboration between researchers, patients, therapists, ethicists, technology developers, and forensic organizations is recommended for timely identification of ethical challenges and suitable solutions. We suggest that patients and therapists should be actively involved throughout all phases of the process, from development of the technology via co-creation to active participation in implementation and evaluation in practice.

Some international jurisdictions route individuals for whom criminal responsibility is foreclosed because of mental disorder from the penal system into a forensic psychiatry regime. Such rerouting might be presumed preferable for such individuals, because it is intended to offer a humane alternative to incarceration and is often viewed by the public as an avenue for accused individuals to avoid accountability. Our clinical experience corroborates European findings that at least some individuals who have been placed into forensic psychiatric care would have preferred to remain in the penal system. We report on our preliminary qualitative investigation into the reasons why some forensic psychiatric inpatients in the Canadian province of Ontario would prefer to be incarcerated. Using a grounded theory methodology, we identify six thematic categories of reasons for this preference. Drawing on these themes, we propose that participants perceive inpatient forensic psychiatric detention as posing a greater threat to personal identity than incarceration as well as feel despair associated with the perceived futility of resisting identity-shaping pressures in this environment. Participants' concerns re-emphasize the clinical challenge, but also the importance, of providers' supporting patients to associate hope rather than harm with the aim of personal transformation through inpatient forensic psychiatric care.

The Tao of Forensic Psychiatry.

The forensic assessment of transgender individuals is challenging because of evolving legal landscapes, sociopolitical tensions, gaps in the clinical literature, and lack of standardized assessments studied in this population. This article explores the complexities forensic psychiatrists encounter when evaluating transgender persons, with an emphasis on assessments of general and sexual violence risk, mitigating factors, sex discrimination, disability, emotional distress, and parenting. The article also addresses the importance of remaining vigilant in striving for objectivity in assessments of transgender individuals while acknowledging both the dearth of population-specific research and the vulnerabilities and risks faced by transgender individuals. Recommendations are made for ongoing research in this field.

This article explores the dispute between the philosopher Immanuel Kant and the physician Johann Daniel Metzger over the moral autonomy of individuals with mental illness. Situating the debate within the broader context of the evolving philosophical and medical professions in eighteenth-century Germany, the article examines how a professional conflict emerged over who - the physician or the philosopher - should serve as the legal authority in cases where moral responsibility was in question. The analysis shows that this was not merely a theoretical issue for Kant, but a practical one, brought to the fore by the infanticide trial of Margarethe Kaveczynska, in which Kant's friend, Theodor Gottlieb Hippel, presided as judge. The article argues that while Kant's vision for the practical application of his anthropology influenced his conception of moral autonomy, he ultimately lost ground to the rising authority of the medical profession.

A case study of forensic psychiatry experts' reports analysis through large language models.

ABSTRACTBackgroundWard design is increasingly recognized as influencing the treatment of psychiatric inpatients. However, evidence on how improved structural surroundings affect aggression and restrictive practices in forensic psychiatry is limited. To our knowledge, no studies have focused on the effect of improved treatment facilities on aggressive behavior and the prescription of restrictive practices among forensic psychiatric inpatients.AimThis study aims to explore whether improved architectural design reduces aggression and prescription of restrictive practices in a population of forensic psychiatric inpatients.MethodsThis retrospective, observational, and longitudinal study included a follow‐up 2 years prior and 2 years post relocating the Department of Forensic Psychiatry at Aarhus University Hospital Psychiatry (DFP‐AUHP) from an old hospital building to new and purpose‐built psychiatric facilities. We included all patients admitted to DFP‐AUHP during the study period; 230 unique patients before and 196 unique patients after the relocation. We compared aggression as measured by the Brøset Violence Checklist (BVC) and prescription of restrictive practices prior to and after the intervention.Data were drawn from the Business Intelligence data portal, which routinely stores data from the Electronic Patient File. Statistical analyses were conducted to explore patient demographics, aggression, and the prescription of restrictive practices.ResultsOverall, restrictive practices were more than halved among the included population of forensic psychiatric patients after the relocation (548 to 246, p value: < 0.001). Additionally, the total daily mean BVC, an indicator of aggressive behavior, was significantly lower post‐relocation (from 0.40 (95% CI: 0.39–0.42) to 0.27 (95% CI: 0.26–0.28), p value: < 0.001). Both summative data and underlying time trends evidence the results.ConclusionOur study suggests a significant reduction in aggressive behavior and restrictive practices following the relocation. The study contributes to understanding how environmental changes can relate to patient outcomes and may be relevant for the design and renovation of psychiatric hospital facilities.Trial RegistrationCentral Denmark Region: 1‐16‐02‐137‐24

Objective: To critically reexamine, from a multidisciplinary perspective encompassing Medicine, Psychiatry, and Dentistry, Cesare Lombroso’s work on the “born criminal” theory, with emphasis on dentofacial correlates and their epistemological and social implications. Materials and Methods: A critical literature review was conducted, including a historical analysis of Lombroso’s formulations within the 19th-century epistemological context. His proposed “degenerative stigmata” in dental and facial morphology were detailed and methodologically deconstructed, then contrasted with contemporary scientific knowledge. Results: Findings indicate that Lombroso’s concepts, although scientifically refuted today, significantly influenced medico-legal thought, psychiatry, and the formative stages of forensic dentistry. These ideas were contrasted with modern evidence on psychopathology (including antisocial personality disorder and psychopathy), craniofacial and dental developmental genetics, and the multifactorial etiology of criminal behavior. Furthermore, the ethical and social implications of Lombroso’s biological determinism were discussed, particularly its historical impact on penal policies and the stigmatization of individuals based on physical traits. Conclusion: Lombroso’s theses are scientifically invalidated, yet they hold heuristic value as a paradigmatic case of the dangers of biased interpretations of morphological variations. This study underscores the imperative for continuous methodological and ethical rigor at the interface of biology, medicine, psychiatry, and dentistry.

IntroductionForensic psychiatry transcends legal and cultural boundaries across Europe, but specialization and training remain inconsistent. With freedom of movement in most European countries, psychiatrists accredited in one country can practice in others if they meet language requirements. Therefore, harmonizing psychiatric education and practice is crucial and aligns with the European Federation of Psychiatry Trainees (EFPT)’s goals.ObjectivesThis study aims to map the current state of forensic psychiatry education across Europe, focusing on its recognition as a specialty on its own or subspecialty, training structure, and financial implications. It also assesses whether general adult psychiatry (GAP) and child and adolescent psychiatry (CAP) trainees receive adequate forensic psychiatry education, identifying gaps and variations across countries.MethodsData was collected via an online survey distributed to European National Trainee Association (NTA) representatives in the EFPT through Google Forms in August 2024. Responses from non-European countries and incomplete entries were excluded. The final dataset was analyzed using SPSS 24.ResultsA total of 29 participants, including 24 GAP trainees (82.8%), 2 CAP trainees (6.9%), and 3 specialists (10.3%), from 20 European countries responded to the survey. Forensic psychiatry was recognized either as a specialty or subspecialty in 13 counctries (65%) with 20 (69%) of participants confirming its recognition. 38% reported forensic training lasts less than 1 year or lacks a formal program. Financial support varied as well, with some countries offering full subsidies, while others required trainees to cover costs. Forensic psychiatry was included in the training of 66.7% of GAP trainee and 50% of CAP trainees, though the depth of exposure differed. Notable gaps were found particularly in risk assessment, expert witness training, and competency evaluations.ConclusionsThis study reveals significant variation in the recognition, structure, and delivery of forensic psychiatry training across Europe. While some countries offer well-defined programs, discrepancies in accessibility and comprehensiveness persist. These findings highlight the need for standardized curricula to ensure consistent training. Enhancing forensic psychiatry education is crucial for preparing future psychiatrists and ensuring high-quality psychiatric contributions in legal contexts and harmonization of forensic training across Europe.Disclosure of InterestNone Declared