The Management of Patients with Psychotic Disorders in Forensic Psychiatry

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Psychiatry".

Deadline for manuscript submissions: 31 December 2024 | Viewed by 4598

Special Issue Editors


E-Mail Website1 Website2
Guest Editor
Department of Clinical and Experimental Medicine, Section of Legal Medicine - University of Foggia, 71122 Roma, Italy
Interests: forensic pathology; legal medicine; forensic psychiatry; bioethics

E-Mail Website
Co-Guest Editor
Department of Clinical and Experimental Medicine, Section of Legal Medicine - University of Foggia, 71122 Roma, Italy
Interests: psychiatry; depression; schizophrenia

E-Mail Website
Co-Guest Editor
Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
Interests: forensic pathology; legal medicine; forensic psychiatry; bioethics

E-Mail
Co-Guest Editor
Department of Clinical and Experimental Medicine, Section of Legal Medicine-University of Foggia, 71122 Roma, Italy
Interests: legal medicine; forensic medicine; forensic psychiatry; forensic gynecology; public health; health policy; population health management; risk management; bioethics; clinical ethics
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

According to DSM-5-TR, a range of perceptive, cognitive, behavioral, and emotional dysfunctions are involved in the diagnostic definition of psychotic disorders. Despite the heterogeneity among studies reporting a risk of violence, psychotic disorders are overall associated with a higher risk of violence than the general population, especially when presenting alongside a substance use disorder.

Although psychotic disorders are characterized by a large burden of disability, both in quantitative (lower life expectancy) and qualitative (social drift) terms, the association with violence makes their evaluation and management even more complex. In forensic psychiatry, psychotic disorders must be carefully evaluated to assess criminal responsibility.

Specifically, the assessment of the mental state of a subject with a psychotic disorder at the time of a crime is a major challenge due to the remarkable qualitative–quantitative variability of the manifestations of this kind of disorder.

Additionally, in the civil field, it is important to verify the presence of specific skills in the subject, such as the ability to sign contracts, make wills, and give consent to medical treatments.

Moreover, in general, it is important to examine the different dimensions that characterize psychotic disorders in both the civil and criminal fields, particularly the presence of hallucinations, delusions, confusion, or cognitive impairment. It is also important to evaluate compliance with drug treatment and the response to it.

The management of people with psychotic disorders is also important in prisons where this could be particularly difficult in relation to complying with pharmacological therapy and the promotion of rehabilitation programs.

Finally, the presence of psychotic disorders in patients undergoing psychiatric treatment can also have an impact on professional liability. The therapeutic management of these patients can configure medical liability in relation to physical and/or pharmacological restraint. Furthermore, in the case of self-injurious and/or hetero-injurious acts by both inpatient and outpatient psychotic patients, there may be legal consequences for medical personnel.

This Special Issue aims to contribute to the progress in medico-legal research in relation to the forensic psychiatric aspects of the management and treatment of psychotic disorders.

This Special Issue will consider the wide range of topics associated with medico-legal and forensic psychiatric issues in the fields of civil and criminal justice, particularly:

  • Criminal responsibility;
  • Civil matter evaluations;
  • Violence in psychosis;
  • Forensic inpatients and outpatients;
  • Prison detention;
  • Medical liability
  • Care and rehabilitation pathways for psychiatric offenders.

We will consider the following paper formats: original articles, research letters, reviews, case reports, and meta-analyses, as well as short communications providing an up-to-date overview of relevant and debated themes of interest in this field.

Dr. Luigi Cipolloni
Guest Editors

Prof. Dr. Antonello Bellomo
Dr. Donato Morena
Dr. Andrea Cioffi
Co-Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • forensic psychiatry
  • legal medicine
  • psychosis
  • suicide
  • violence
  • culpability
  • professional liability
  • psychiatric hospital
  • correctional psychiatry

Benefits of Publishing in a Special Issue

  • Ease of navigation: Grouping papers by topic helps scholars navigate broad scope journals more efficiently.
  • Greater discoverability: Special Issues support the reach and impact of scientific research. Articles in Special Issues are more discoverable and cited more frequently.
  • Expansion of research network: Special Issues facilitate connections among authors, fostering scientific collaborations.
  • External promotion: Articles in Special Issues are often promoted through the journal's social media, increasing their visibility.
  • e-Book format: Special Issues with more than 10 articles can be published as dedicated e-books, ensuring wide and rapid dissemination.

Further information on MDPI's Special Issue polices can be found here.

Published Papers (3 papers)

Order results
Result details
Select all
Export citation of selected articles as:

Research

Jump to: Review, Other

13 pages, 325 KiB  
Article
Predictors of Defensive Practices among Italian Psychiatrists: Additional Findings from a National Survey
by Donato Morena, Nicola Di Fazio, Pasquale Scognamiglio, Giuseppe Delogu, Benedetta Baldari, Luigi Cipolloni, Paola Frati and Vittorio Fineschi
Medicina 2023, 59(11), 1928; https://doi.org/10.3390/medicina59111928 - 31 Oct 2023
Cited by 2 | Viewed by 1482
Abstract
Background: Defensive medicine is characterized by medical decisions made primarily as a precaution against potential malpractice claims. For psychiatrists, professional responsibility encompasses not only the appropriateness of diagnosis and treatment but also the effects of their interventions on patients and their behaviors. [...] Read more.
Background: Defensive medicine is characterized by medical decisions made primarily as a precaution against potential malpractice claims. For psychiatrists, professional responsibility encompasses not only the appropriateness of diagnosis and treatment but also the effects of their interventions on patients and their behaviors. Objective: To investigate the socio-demographic, educational, and occupational characteristics and work-related attitudes that may serve as predictors of defensive medicine among Italian psychiatrists. This research extends the results of a previous analysis based on a national survey. Methods: A secondary analysis of the database of a national survey on attitudes and behaviors of Italian psychiatrists regarding defensive medicine and professional liability was performed for this study. Results: Among 254 surveyed psychiatrists, 153 admitted to practicing defensive medicine, while 101 had this attitude with less than half of their patients. The first group was predominantly comprised of women (p = 0.014), who were younger in age (43.34 y 9.89 vs. 48.81 y 11.66, p < 0.001) and had fewer years of professional experience (12.09 y ± 9.8 vs. 17.46 y ± 11.2, p < 0.001). There were no significant differences in prior involvement in complaints (p = 0.876) or the usual place of work (p = 0.818). The most prominent predictors for practicing defensive medicine were (1) considering guidelines and good clinical practices not only for their clinical efficacy but also or exclusively for reducing the risk of legal complaints for professional liability (OR = 3.62; 95%CI, 1.75–7.49), and (2) hospitalizing patients with violent intentions even if not warranted according to their mental state (OR = 2.28; 95%CI, 1.50–3.46, p < 0.001). Prioritizing protection from professional liability over patients’ actual needs in prescribing or adjusting drug dosages and in involuntary hospitalization, as well as prescribing lower dosages than recommended for pregnant patients, were identified as additional predictors. Finally, years of professional experience exhibited a protective function against defensive practices. Conclusions: Psychiatrists advocate the need to implement a ‘risk management culture’ and the provision of more balanced duties in order to ensure ethical and evidence-based care to their patients. A particular source of concern stems from their professional responsibility towards not only the health of patients but also their behavior. However, these aspects conflict with a limited potential for assessment and intervention based on effective clinical tools. A reform of professional liability that considers the specificities of patients cared for by mental health services could contribute to reducing the risk of defensive medicine. Full article

Review

Jump to: Research, Other

15 pages, 617 KiB  
Review
The Relationship between Cognitive Impairment and Violent Behavior in People Living with Schizophrenia Spectrum Disorders: A Critical Review and Treatment Considerations
by Gabriele Nibbio, Lorenzo Bertoni, Irene Calzavara-Pinton, Nicola Necchini, Stefano Paolini, Antonio Baglioni, Daniela Zardini, Laura Poddighe, Viola Bulgari, Jacopo Lisoni, Giacomo Deste, Stefano Barlati and Antonio Vita
Medicina 2024, 60(8), 1261; https://doi.org/10.3390/medicina60081261 - 3 Aug 2024
Viewed by 1209
Abstract
Cognitive impairment is a core feature of schizophrenia spectrum disorders (SSD). Violent and aggressive behavior represents a complex issue in psychiatry, and people with SSD have been shown to be at risk of being both victims and perpetrators of violence. In this review, [...] Read more.
Cognitive impairment is a core feature of schizophrenia spectrum disorders (SSD). Violent and aggressive behavior represents a complex issue in psychiatry, and people with SSD have been shown to be at risk of being both victims and perpetrators of violence. In this review, the complex relationship between cognitive impairment and violent behavior is explored, also considering the usefulness of treating cognitive impairment to improve violence-related outcomes. Several studies report that cognitive impairment is linked to violent behavior, but significant differences between domains and conflicting results are also present, leaving the identification of specific cognitive profiles predicting violent behavior in SSD as an important aim for future research. Evidence regarding the effectiveness of treating cognitive impairment to improve violent behavior, while heterogeneous, provides more consistent results: cognition-targeting interventions appear to provide significant benefits also in the prevention of aggression in people living with SSD, and preliminary evidence shows cognition-focused interventions targeting violent behavior improve both cognition- and violence-related outcomes. Implementing these interventions in clinical practice could be of great usefulness, particularly in forensic contexts. Physical exercise, which improves cognitive performance and psychosocial functioning in SSD, appears to reduce violent behavior in healthy individuals, but requires further studies in clinical samples. Full article
Show Figures

Figure 1

Other

Jump to: Research, Review

16 pages, 977 KiB  
Systematic Review
Is There a Relationship between Psychotic Disorders and the Radicalization Process? A Systematic Review
by Pierluigi Catapano, Salvatore Cipolla, Corrado De Rosa, Stefania Milano, Daniela Vozza, Davide Guadagno, Francesco Perris, Gaia Sampogna and Andrea Fiorillo
Medicina 2024, 60(6), 926; https://doi.org/10.3390/medicina60060926 - 1 Jun 2024
Viewed by 1206
Abstract
Background and Objectives: Radicalization, a complex and multifaceted phenomenon, has been a subject of increasing concern in recent years, particularly due to its potential connection to acts of mass violence and terrorism. This systematic review examines the intricate link between radicalization and [...] Read more.
Background and Objectives: Radicalization, a complex and multifaceted phenomenon, has been a subject of increasing concern in recent years, particularly due to its potential connection to acts of mass violence and terrorism. This systematic review examines the intricate link between radicalization and psychotic disorders, utilizing various sources such as observational studies, case reports, and series. It aims to highlight the prevalence of schizophrenia spectrum and other psychotic disorders among radicalized individuals and to define the role of mental health professionals in dealing with this issue, contributing to the development of prevention and treatment strategies. Materials and Methods: The methodology involved an extensive literature search across PubMed, Scopus, and APA PsycINFO up to 1 February 2024, adhering to PRISMA guidelines. The study focused on radicalization and psychotic disorders as defined by DSM-5 criteria, excluding other mental disorders. A population sample of 41 radicalized individuals diagnosed with psychotic disorders was selected, among which schizophrenia was identified as the predominant condition. Results: It was observed that 24% of these individuals passed away soon after committing their crimes, leading the researchers to rely on retrospective data for their diagnoses. The use of diverse assessment tools for psychiatric diagnosis and the lack of a standardized method for diagnosing or assessing involvement in the radicalization process were also noted. Despite limitations like reliance on observational studies and case reports, which result in low evidence quality and varied methodologies, our work provides a valuable contribution to clarifying the relationship between radicalization and psychotic disorders. However, further clinical studies are needed to delve deeper into these aspects. Conclusions: In conclusion, our review points out that individuals with psychotic disorders do not have a higher crime rate than the general population and warns against associating crimes with mental illness due to the stigma it creates. The lack of uniform psychiatric diagnostic tools and radicalization assessment highlights the need for more standardized risk assessment tools and validated scales in psychiatric diagnosis to better understand the relationship between radicalization and psychotic disorders and to develop integrated protocols. Full article
Show Figures

Figure 1

Back to TopTop