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Germann, Urs. "Psychiatrie und Strafjustiz : Entstehung, Praxis und Ausdifferenzierung der forensischen Psychiatrie in der deutschsprachigen Schweiz 1850-1950 /." Zürich : Chronos, 2004. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=012799908&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA.
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Carey, John Fernando. "Initial assessment in forensic psychiatry : the forensic assessment format as a boundary object." Thesis, Durham University, 2017. http://etheses.dur.ac.uk/12134/.
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This research project offers initial assessment in forensic psychiatry a new assessment guideline, the Forensic Assessment Format, (Carey 2006) which is a development from Jane Ussher’s material-discursive-intrapsychic model of critical realism, (Ussher 2000a). It presents a review of the technical and theoretical literature looking at the development of assessment methods in forensic psychiatry and discusses current practice and how a critical realist perspective could inform the assessment process. It is a qualitative study using both an empirical and an analytic auto-ethnographic approaches, (Anderson 2006). The research project presents data from 19 semi-structured interviews and a focus group analysed using grounded theory, (Glaser and Strauss 1967) to aid both deductive and abductive approaches, (Timmermans and Tavory 2012). Service users were involved from the beginning of the project to inform the themes that developed into the interview questions. The outcomes of the study offer support for the potential of this critical method of initial assessment to be collaborative, holistic and inclusive and that it could act as a boundary object, (Star and Griesemer 1989), between different social worlds providing a bridge for information to flow. This encourages cooperation in completing the assessment and then formulating and meeting the identified needs. It explores and provides an insight into the initial assessment process in forensic psychiatry from the perspective of the service user, referrer and assessor. Further suggestions are offered in associated areas such as how plural realities can be understood and how the assessment process in forensic psychiatry could be further improved.
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St, Denis Emily Elizabeth. "Forensic psychiatry and criminal responsibility in Santiago, Chile." Thesis, Kingston, Ont. : [s.n.], 2008. http://hdl.handle.net/1974/1467.
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Nugent, Stella. "Forensic aspects of intellectual disabilities and autism spectrum disorders." Thesis, University of Nottingham, 2016. http://eprints.nottingham.ac.uk/34777/.
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Overview This thesis reviewed forensic aspects of Intellectual Disabilities (ID) and Autism Spectrum Disorder (ASD). Chapter two was a case study where an individual with ID and ASD who exhibited forensic/Challenging Behaviour (CB) was assessed and intervention offered. Chapter three then focussed on the assessment of people with ID and ASD by critiquing the Wechsler Adult Intelligence Scale (WAIS), version 3 and 4 (WAIS-III & WAIS-IV) (Wechsler, 1997; Wechsler, 2008a, 2008b, 2008c) and discussed application issues for people with ID and ASD. Chapter 4 and 5 examined intervention in more depth. Chapter 4 applied Weiner’s (1985, 1993) theory of achievement, motivation and emotion as a way of understanding contextual intervention and Chapter 5 examined the effect of psychotherapeutic interventions on CB. Chapter Two The case study discussed in chapter two examined explanations of violence and diagnoses. ASD and an ID were identified as useful neurodevelopmental diagnoses that could be used as a framework to understand the individual’s needs. Some explanations of violence were related to features of these diagnoses. Social factors were also identified as increasing risk. Violence was modelled by a key male figure during childhood development which appeared to have been retained as a template of acceptable behaviour, supporting the work of Bandura on social learning (1973). This, and the experience of being a victim of this violence, also supported the work of Douglas, Hart, Webster and Belfrage (2013) who indicated that social factors can increase the risk of violence. In turn this affected attachment supporting the work of Bowlby (1980). The behavioural approach (Cipani & Schock, 2010) was also applied to identify functions of violence. A psychotherapeutic intervention was offered to improve one aspect of emotional recognition, face perception, with the aim of enabling him to comprehend visual feedback from the environment, make interpretations about the emotions experienced by others, and modify his behaviour accordingly. There was little difference to his level of skills following the intervention. It was concluded that particular skills development may be difficult for someone with a neurodevelopmental difficulty if the biological structures are not there to support that skill, or skills may take a long time to develop. In this case it was concluded that the best intervention was to consider a placement for him in an appropriate environment that would cater for his ASD and ID related needs. Comments were made about the quality of assessments and for improvements to be considered to formulation and intervention. Chapter Three Chapter three was a critique of the WAIS, a tool widely used as part of the process to identify whether someone has an ID. This may determine if an individual may be unfit to plead in court or to determine the services appropriate for that individual’s needs. The review focussed on the most recent version, WAIS-IV (Wechsler, 2008a, 2008b, 2008c) but also referred to other versions in particular the WAIS-III (Wechsler, 1997). The conclusion was there were some flaws to the assessments that required further research and also some omissions in the epistemology. The critique examined different aspects of validity and reliability. The examination of convergent validity yielded mixed results with some positive correlations with other tests and some weak correlations. This difference could be caused by some tests measuring different aspects of ‘g’. The consequences of differences can be significant, for example the scores of the Wechsler Intelligence Scale for Children, version 4 (WISC-IV) (Wechsler, 2003) and the WAIS-IV scores could differ by up to 10 points and could mean individuals moving from a children’s to an adult service could become ineligible for the same levels of support. The results for test-retest reliability were good in the short term but more research was recommended to determine if the latest version of the WAIS would be reliable in the long term. The ‘Flynn effect’ (Flynn, 2007) indicated that levels of intelligence were rising so the WAIS-IV compensated for this and currently measures intelligence at around 3 points lower than the WAIS-III. The stability of this effect was unclear. The results for internal reliability were good although more research independent of the WAIS was recommended. The application of the WAIS for individuals with an ASD and ID was considered with the WAIS being found to be a limited tool for discriminating between categories of ASD, although what can be expected is an uneven profile. It was also unclear how useful the WAIS was to discriminate between individuals with a substance misuse/abuse disorder and normal controls. There were also difficulties with the application of the WAIS to individuals with ID. Difficulties measuring intelligence at lower levels were identified as scores can be unstable. Research was also recommended to provide a comprehensive view of the effect upon results of variables such as nationality, gender and age. Chapter Four Chapter four was an empirical research project investigating Weiner’s (1985, 1993) theory of achievement, motivation and emotion as a means of understanding the responses of unqualified nursing staff to clients with ASD exhibiting CB. One hundred and twenty seven unqualified nursing staff responded to an Attributional Style Questionnaire (ASQ) (Dagnan & Cairns, 2004) and questions based on a vignette. The quantitative results found weak support for Weiner’s model. There was weak evidence for the effect of demographic variables and the type of client (ASD or ID) and the type of service (ASD or Mental Health/ID) did not affect the results. Qualitative data was themed and coded according to Braun and Clarke (2006) and Boyatzis (1998) and provided an insight into the psychological processes influencing staff responses to CB. The results suggested that intervention was influenced by staff, patient and contextual variables. A recommendation was made for a contemporary exploration of the topic and to improve the validity and reliability of the ASQ. Chapter Five Chapter five was a systematic review of psychotherapeutic interventions aimed at reducing the CB exhibited by people with ID only due to a paucity of research using people with ASD as participants. A systematic literature search was conducted using 5 databases, a search of relevant journals and contact made with experts. From this 8 papers met the inclusion/exclusion criteria and these were analysed qualitatively. Three types of psychotherapeutic intervention were used within the ten papers, Cognitive Behavioural Therapy (CBT), “Soles of the Feet” meditation and Solution-Focussed Brief Therapy. All types of psychotherapeutic intervention reduced CB although the results of studies using CBT were mixed. There were shortcomings to these conclusions; these were methodological issues such as a need to ensure the consistency of outcome measures and the types of CB used to measure change. The effect of intervention may have been modified by variables such as length of treatment, the context and intrapersonal variables. Conclusions The chapters of this research thesis indicated that neurodevelopmental factors influenced forensic/CB, although social role models, attachment and trauma were also significant. Assessments were important as they may affect fitness to plead and services/treatment offered. Assessments such as the WAIS are supported by research although further research has been recommended. The use of the WAIS with people with ASD and ID was limited as people with ASD appear to exhibit uneven profiles when completing the WAIS and there were inaccuracies when using the WAIS with people with lower levels of intelligence. The difficulties people with ASD have with social communication skills can also affect performance and support is needed when administering assessments. Intervention for people with a neurodevelopmental difficulty can also be successful. Consideration is needed regarding appropriate intervention for each individual, how long before the intervention is effective, the context including the type of support offered and how that affects outcomes, intrapersonal variables such as intelligence, and whether the treatment includes one to one support. More research of an improved quality is required to determine the effectiveness of both assessment and treatment including contextual based treatment such as the interaction between staff and patients within an institutional setting. Considering these further would improve the service for this client group and contribute to a reduction of risk.
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Långström, Niklas. "Young sex offenders : individual characteristics, agency reactions and criminal recidivism /." Stockholm, 1999. http://diss.kib.ki.se/1999/91-628-3530-0/.
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Pettersson, Natalie. "DBT as a general approach in forensic psychiatry. : - Evaluation of patients' Global Assessment of Functioning at the Clinic of Forensic Psychiatry in Växjö." Thesis, Linnéuniversitetet, Institutionen för pedagogik, psykologi och idrottsvetenskap, PPI, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-20634.
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Al, Awam Khaled. "The study of biomarkers for psychiatric disorders and their potential application in clinical and forensic psychiatry." Thesis, Swansea University, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.678476.
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Wyse, Kate. "Treatment engagement of people in forensic personality disorder services." Thesis, University of Nottingham, 2016. http://eprints.nottingham.ac.uk/31668/.
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This thesis explores the contribution of the Personal Concerns Inventory (PCI; Cox & Klinger, 2000) to the development of treatment engagement strategies with people with personality disorder (PD) in forensic settings. A systematic literature review of evaluated engagement strategies with offenders and people with PD showed little diversity in terms of strategies evaluated with PD, specifically psycho-education and goal-based interventions only (Chapter 2). Furthermore current literature focuses mainly on motivational interviewing (MI) in offenders as somewhat useful in increasing motivation to engage and change. However preliminary support for node-mapping and interactive activities has been found in a small number of studies. The distinct lack of strategies with PD is problematic considering the high treatment non-completion rates with this population and the case study in Chapter 3 discusses the complexity of working with patients with PD. It finds Dialectical Behaviour Therapy (DBT), which embeds motivational strategies in its programme, as improving not only treatment retention but also clinical outcomes, thereby offering further encouragement in focusing engagement strategies with PD. Consequently, a critique of the PCI was necessary in understanding the PCI as both a measure of motivation to change and a motivational intervention. This semi-structured interview demonstrates reasonable reliability and validity however the offender variants’ psychometric properties are weaker. The robust theoretical basis of the PCI and the consistent positive qualitative feedback from participants suggests value in evaluating the tool as a motivational intervention. Thus Chapter 5, an empirical study, evaluates the PCI followed by goal counselling as a motivational intervention with people with PD using a mixed-methods approach and a small number multiple baseline design. The quantitative results offer limited support for the effectiveness of the PCI or understanding of the process of change. However the qualitative data reflects that in existing PCI literature: participants perceived it as effective in focusing them on their goals and the relevance of treatment, thereby enhancing motivation. Therefore further investigations are needed to clarify discrepancies between participant perception and the outcome measure data in order to understand the extent to which the PCI enhances motivation. The final chapter summarises the thesis’ findings, the impact for research and clinical practice, the main limitations of this thesis, and makes recommendations for future research. Overall, the complex and idiosyncratic manifestation of a diagnosis of PD and the numerous external and internal factors affecting the engagement of people with PD recommend tailored assessment and intervention using a client-led approach.
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Richardson, Clare Louise. "Structured professional judgement of risk in forensic psychiatric practice." Thesis, University of Nottingham, 2009. http://eprints.nottingham.ac.uk/12067/.
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The central issue addressed in this thesis was the validation of a novel risk assessment system designed to meet the security requirements of a high secure forensic hospital. To this end, three research strands investigating the clinical, predictive and preventative utility of the system were pursued. This thesis reports the process of the development, adaptation and implementation of a system based on the HCR-20, called the Structured Clinical Judgement: Risk (SCJ: Risk). The first research strand involved investigation of the processes necessary implement a system of structured professional judgement. The conceptual and operational utility of the system were investigated, and successful implementation of the system within clinical practice was demonstrated by compliance of use by clinical teams. A survey was conducted, investigating the perceptions of clinicians in relation to the clinical utility and usability of the SCJ: Risk. Overall acceptance of the pilot and implementation phase of the system was demonstrated, and the system was perceived to assist clinical teams to structure and document risk-related decisions. The second research strand studied the validity of the SCJ: Risk in predicting intra-institutional behaviour. A prospective investigation of the application of the SCJ: Risk to a forensic population detained in conditions of high security was conducted and this demonstrated variation in the predictive utility of the system. The predictive accuracy of subscale items of the SCJ: Risk, and the individual risk factors comprising the subscales of the system were robust for behaviours relevant to violence and suicide/self-harm. However, prediction of behaviours relevant to escape/abscond, vulnerability to risk from others and subversion of security were not demonstrated. The third research strand involved exploration of the preventative utility of the system, specifically if the identification of a patient as high-risk would minimise the occurrence, or prolong the time to an incident of intra-institutional behaviour. Results illustrated the efficacy of the SCJ: Risk system in the identification of high risk individuals for behaviours relevant to any intra-institutional infraction, violence and self-harm. Patients identified as high-risk displayed a higher prevalence and earlier incidence of relevant intra-institutional behaviour. It is concluded that the system of Structured Clinical Judgement: Risk (as an adaptation of the HCR-20) contributes positively to the overall goals of clarity of risk communication, identification and management of high risk patients within forensic psychiatric practice. However, the extended risk assessment of the SCJ: Risk does not make a significant additional contribution to the parental system on which it is based.
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Sturidsson, Knut. "Measures in forensic psychiatry : risk monitoring and structured outcome assessment /." Stockholm : Karolinska institutet, 2007. http://diss.kib.ki.se/2007/978-91-7357-262-0/.
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Dickens, Geoff. "Nursing in secure and forensic psychiatry : contexts, contributions and concepts." Thesis, University of Northampton, 2011. http://nectar.northampton.ac.uk/8854/.
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Bergqvist, Caroline, and Sofia Tingberg. "En fråga med dolda svar : en registerstudie." Thesis, Högskolan Väst, Avdelningen för omvårdnad - avancerad nivå, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:hv:diva-9411.
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Background: Since 2008 there is a law stating that patients who do not require institutional forensic psychiatric care may be moved to non-institutional forensic care, with special conditions. RättspsyK is a national quality register where all of the 25 forensic care units in Sweden collect information about their patients and their care. Previous analysis showed that a considerable amount of patients continue to receive institutional forensic psychiatric care despite they are assessed and found ready to move onto non-institutional forensic care. Aim: The objective of this study was to identify factors affecting why patients were still in institutional forensic care despite assessed to be ready for non-institutional forensic care.Method: First, yearly assessment of each patient between 2009 and 2014 was drawn from the RättspsyK register. Answers to the specific question, Question 10, were analyzed with descriptive statistics and were planned to be used in regression analyses as dependent variable. Result: 1900 patients were included. During analyses the fact that answers to this question were not trustable was found, therefore no exact prevalence of inpatients kept in institutional forensic care despite assessed ready for non-institutional care could be determined. Other information revealed that lack of housing and lack of collaboration were the most frequent reasons for this phenomenon. Conclusion: The present study could not give answer to the original question, but pointed out avalidity problem in the Swedish Forensic Psychiatry Register. The result calls for caution and for the need of validation of RättspsyK register.
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Chou, Jen-Yu. "The psychiatric politics of risk and cost : forensic theory and practice in the US and Taiwan /." Thesis, Connect to this title online; UW restricted, 2006. http://hdl.handle.net/1773/6567.
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WURSTEN, APRIL. "THE PSYCHOLOGIST AND PSYCHIATRIST IN COURT: PERCEIVED EXPERTNESS AND INFLUENCE." Diss., The University of Arizona, 1986. http://hdl.handle.net/10150/183929.
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An analog study was devised to examine perceived differences between psychiatrists and psychologists in providing expert testimony on the insanity defense. The effects of issue involvement and initial attitude were also assessed. Subjects who had been exposed to the differences in training between the professionals were used. In a pilot investigation, subjects were exposed to identical testimony from a defense expert identified either as a psychiatrist or psychologist. Medical bias, as measured by the tendency to concur with the expert recommendations and endorse attitudes consistent with the M.D., was confirmed. This finding was especially strong among pro insanity defense subjects with low issue involvement. The failure to find a similar pattern among anti-insanity defense subjects with low issue involvement was thought to be an artifact of the absence of opposing testimony. The overall failure of highly involved anti insanity defense subjects to reach verdicts consistent with their initial attitudes, was also thought to result from the lack of opposing testimony. The primary study was designed to clarify the findings of the pilot investigation and to approximate a more authentic court situation by including an opposing expert. Witness credentials were manipulated while testimony remained constant. Some subjects were exposed to the Ph.D. for the defense and M.D. for prosecution and others to the M.D. for the defense and Ph.D. for the prosecution. Medical bias was evident in this study, again measured by the tendency to follow the recommendations of the M.D. and endorse attitudes consistent with those recommendations. Additionally, subjects tended to evaluate the psychiatrist more favorably than the psychologist. Subjects with low issue involvement were more susceptible to the influence of the medical expert. Highly issue involved subjects maintained their initial attitudes. Attitudes, issue involvement and credentials seemed to affect memory for facts of the case. In some instances, initial attitudes became stronger when mock jurors were exposed to the opposing view (polarization). Implications and limits of these findings were explored.
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Kelly, Brendan D. "Custody, care and criminality : clinical aspects of forensic psychiatric institutionalisation in late nineteenth- and early twentieth-century Ireland." Thesis, University of Northampton, 2011. http://nectar.northampton.ac.uk/8866/.
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Sowemimo, S. "The forensic relevance of sexual fantasy : internal mental models, self-representation and personality." Thesis, University of Nottingham, 2016. http://eprints.nottingham.ac.uk/32714/.
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Practitioners working within forensic environments will be acutely aware of the diverse risks, complex treatment needs and unique responsivity issues found within the multifaceted marginal group of sexual offenders. Deviant sexual fantasy (DSF) is considered to be important in the assessment and treatment of sexual offenders. Despite the recent growth in research, conclusions remain inconsistent on the significance of fantasy in offending behaviour. Furthermore, the underlying structural components of fantasy remain relatively unexplored. The aim of this thesis was to explore the forensic relevance of the fantasy phenomenon predominantly related to sexual offending populations. This was done by investigating the cognitive components of fantasy in regards to the intersection between fantasy, cognition, personality and self-representation (the latter constructs being considered as reflections of individual internal mental models). Chapter one provided a context to the thesis by presenting an argument that fantasy is forensically relevant in terms of implicit beliefs (offence supportive), cognitions (cognitive distortions, offence supportive beliefs) and personality organisation and functioning (e.g. coping mechanisms). Chapter two detailed a literature review following a systematic approach, exploring the role of fantasy within sexual offending behaviour. Sixteen studies were included in the review. An associative relationship was found between offence supportive fantasy and sex offending behaviour. Personality (among others) was identified as one of the moderating factors within this relationship. However, key methodological limitations with the included studies were discussed. Chapter three utilised a case study approach to consider the complexities of assessment and treatment for a medium risk internet sexual offender (ST). This chapter explored ST’s vulnerabilities in depth (low self-esteem, interpersonal difficulties, emotional dysregulation, rigid cognitive style) and provided a comprehensive assessment and formulation of risk (fantasy experiences reinforce offence supportive attitudes and cognitive distortions). Results suggested that fantasy could be mapped onto personality, organisation and functioning. ST’s fantasy life was considered a latent variable that only became an acute and dynamic risk factor when combined with his distorted attitudes. Chapter four detailed a critique of the MCMI-III. Specific emphasis was placed on assessing the utility of the measure within forensic settings and how this could supplement assessment of fantasy experiences. The tool was found to be psychometrically stable, however it was suggested that use with a sex offender population is approached with caution. Chapter five investigated associations between personality, fantasy proneness and sexual fantasies, in addition to exploring the function and structural components of sexual fantasy. An anonymous electronic questionnaire (containing several psychometric questionnaires e.g. IPIP-50, WSFQ, CEQ) was presented online for a period of 12 weeks. 259 males participated in the study. Links to fantasy proneness, certain personality markers (e.g. agreeableness, intellect/imagination) and early abusive experiences were found. Static fantasy experiences were associated with conscientiousness. Behavioural expression of fantasy was associated with extraversion. ‘Vividness’ of sexual fantasy was explained by the following themes: 1) Boundaries of imagination 2) Context 3) Structure of fantasy and, 4) Fantasy-Reality distinction. Finally, chapter six provides a conclusion to the thesis by summarising the main findings, with particular emphasis on how findings relate more directly to the fantasy phenomenon. The main suppositions and recommendations are as follows: • Fantasies prime self-other associations. Thus, indirect measures of fantasy may be useful and allow the cognitive mapping of fantasy. • A tiered definition of offence related fantasy is recommended pertaining to frequency, vividness, level of intrusion and the risk relevance. • Control (and disintegration of), coping and cognitive capabilities are implicated as important concepts for fantasy prone individuals. To a certain point, offence related fantasy may act as a protective factor for some individuals, until the fantasy can no longer satiate their needs. • The temporal ordering of fantasy function is important in determining risk relevance pertaining to protective factors (emotional regulation), risk inducing factors (priming offender identity) and high risk situations. • Fantasy generation is a skill; the more involvement an individual has with their internal world the more adept they will be at generating complex fantasy experiences and, in turn, the more enmeshed fantasy and reality can become. • Grounding techniques and acceptance commitment therapy may be a useful treatment recommendation for individuals that experience offence related fantasy. Discussion is augmented within contemporary theoretical perspectives in order to consider clinical implications. Limitations of the current thesis and recommendations for future research are also outlined.
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Hansson, Desiree Shaun. "A prototype fact sheet designed for the development of a forensic computerized information system at Valkenberg and Lentegeur Hospitals." Master's thesis, University of Cape Town, 1987. http://hdl.handle.net/11427/15865.
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Includes bibliography.The discussion in this paper centers around the development of a paper-and-pencil fact sheet for collecting and systematizing forensic case material. This paper-and-pencil device is the prototype fact sheet that will be used to collect the data to form a computerized, forensic information system. The system, known as FOCIS, the Forensic Computerized Information System, will serve the largest Forensic Unit in the Western Cape, at Valkenberg Hospital, and the new unit that is being developed at Lentegeur Hospital. FOCIS will comprise case material from all forensic referrals to these two hospitals, under the present law: Sections 77, 78 and 79 of the Criminal Procedure Act 51 of the 1st of July 1977. Additionally, FOCIS will develop dynamically, continuing to incorporate case material as referrals are made to these hospitals. The estimated 7500 cases that will constitute FOCIS by the time this project is completed, include all of the officially classified population groups of South Africa, i.e. the so-called 'black', 'coloured' and 'white' groups [POPULATION REGISTRATION ACT, 1982]. The prototype fact sheet has a schematic layout and uses a mixed-format for data collection, i.e. checklists, multiple choice answer-options and semi-structured narrative text.
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Harrison, Antonia C. "Personality disorder : complex cases or difficult cases? : a question of placement in forensic services." Thesis, University of Nottingham, 2015. http://eprints.nottingham.ac.uk/29079/.
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This thesis explored whether patients in high security hospitals are more ‘Complex Cases’ or more ‘Difficult Cases’ than their counterparts in lower security settings. Herein, case complexity is associated with co-morbid diagnoses or clinical needs, whilst case difficulty refers to challenging, violent and aggressive behaviour. A systematic literature review examined institutional violence and aggression in different security settings within healthcare and prison environments. No clear differences were found in frequency of incidents between the security levels, and a suggestion that the severity of incidents were greatest in lower security had limited generalisability. The results were confounded by data incompatibility, meaning that it could not be concluded that higher security sites house the more ‘Difficult Cases’. An empirical research study examined differences in clinical complexity between personality disordered (PD) patients living in high and medium security units (MSUs). Statistical differences were found on several clinical and forensic variables between settings, including age at first conviction, and difficulties with affective instability, paranoia and depression (assessed with the Personality Assessment Inventory; PAI). This led to the development of a Model of a Complex Case of PD. The results suggested that higher security sites do treat a greater number of ‘Complex Cases’ of PD. Interestingly, they were also found to house a greater number of physically violent patients than the MSUs, ie. more ‘Difficult Cases’. A case study examined a high security PD patient, ‘Andrew’. His assessment, formulation and violence relapse prevention treatment were presented and discussed. It was identified that on admission Andrew was a match to the Model of a Complex Case of PD, and that a lowering of his PAI score profile over time reflected his treatment gains and lessening of his clinical difficulties. When preparing to transition to an MSU, Andrew could no longer be classified as complex, according to the Model. Finally a critique of the PAI psychometric was presented. The tool was assessed for reliability and validity as a measure of clinical psychopathologies, interaction styles and treatment needs, and was praised for its utility with PD patients. The findings from the thesis chapters were reviewed, and the application of the Model of a Complex Case of PD was also discussed. It was concluded that the high security hospital currently provides treatment services to more ‘Complex Cases’ of PD and more ‘Difficult Cases’ than the investigated medium security counterparts. Please note that Chapter 3, which details a confidential patient case study, has been redacted.
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Willmot, Phil. "The process of change in the treatment of personality disorder in a forensic inpatient setting." Thesis, University of Nottingham, 2016. http://eprints.nottingham.ac.uk/33978/.
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This thesis explores the question, what are the important change processes in the treatment of personality disorder in a male forensic inpatient setting? A number of empirically supported therapies for personality disorder stress the importance of the therapist-client relationship in the change process. Therapist-patient relationships are therefore an important focus in this thesis. However, given the lack of research into change processes in this population, the focus is not limited to the therapist-patient relationship, but also considers other relationships and other aspects of the treatment milieu. A model of change processes for this patient group is developed through a series of studies. The first study, in chapter 3, is a qualitative investigation of patients’ perceptions of the process of change and the factors involved. Twelve patients completed a semi-structured interview and the results were analysed using thematic analysis. The study concludes that the cognitive dissonance between how patients expect to be treated and how they are actually treated is an important factor in motivating them to engage in treatment. It also concludes that the therapist-patient relationship and the wider interpersonal environment are both important to therapeutic change with this population. Chapters 4 and 5 describe the process of developing an appropriate dependent outcome measure for the thesis. Social functioning was selected as the dependent outcome variable. Chapter 4 is a systematic review of social functioning measures used with people with a diagnosis of personality disorder and concludes that there is a need to develop a new self-report measure specifically for people with a diagnosis of personality disorder in inpatient settings. Chapter 5 describes the development and validation of this new measure, the Hospital Social Functioning Questionnaire (HSFQ). Fifty-four patients completed a range of measures including the HSFQ. The HSFQ shows good internal consistency, test-retest reliability and concurrent validity with other measures. It appears to measure different aspects of social functioning from the Global Assessment of Functioning (GAF), the most widely used social functioning measure, and the two measures appear to complement each other. Chapter 6 is a quantitative study using the HSFQ and a self-report measure of patients’ perceptions of therapeutic change processes to test the initial model of change developed in chapter 3. Fifty patients completed a checklist about how they had changed during treatment and the factors that had contributed to that change, as well as measures of social functioning. Self-reported levels of change were highly correlated with measures of patient functioning, though significant levels of change did not occur until the latter stages of treatment. The behaviour of therapists was particularly important throughout treatment, though participants in the final stage of therapy reported that the behaviour of other staff was as important as that of therapists, suggesting that, by this stage of treatment they are able to extend their range of supportive and therapeutic relationships. The results support a limited reparenting attachment-based model of therapeutic change. Chapter 7 is a pattern matching study that tests and refines the model of change. Ten patients completed a semi-structured interview about their interactions with their therapist. Their responses were analysed using a modified version of pattern matching to test hypotheses generated by the limited reparenting attachment-based model of change. The results support the limited reparenting model and suggest that patients’ attachment relationships with their therapists are an important change process for this population, particularly in the earlier stages of treatment. Chapter 8 presents a three-stage model of change based on the results of this thesis. On first admission, patients enter the orienting/ cognitive dissonance phase, in which they start to engage in treatment after perceiving a consistent improvement in how they are currently regarded and treated compared to how they have been regarded and treated previously, particularly in prison. Next, they enter the reparenting phase, during which their relationship with their therapist is the most important factor affecting change. Many features of the therapist-patient relationship during this phase parallel attachment processes between children and caregivers. Finally, patients enter the exploration/ generalisation phase in which they are able to explore from the secure base of their relationship with their therapist and develop supportive and therapeutic relationships with other staff members. This model provides a useful framework for working therapeutically with this patient group.
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Richter, Elisabeth. "Johann Christian August Heinroth (1773-1843) als forensischer Psychiater." Doctoral thesis, Universitätsbibliothek Leipzig, 2012. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-89207.
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Die vorliegende Publikationspromotion setzt sich mit dem forensisch-psychiatrischen Werk und Schaffen des ersten abendländischen Lehrstuhlinhabers für Psychiatrie und Begründers der Leipziger Universitätspsychiatrie Johann Christian August Heinroth (1773-1843) zu Beginn des 19. Jahrhunderts auseinander. Die Schwerpunkte dabei sind dessen eigene Gutachtertätigkeit und sein Konzept der Zurechnungsfähigkeit.
Anhand ausgewählter Schriften wurde eine textnahe Lektüre durchgeführt, um Heinroth losgelöst von Kontexten und Kategorien direkt verstehen zu können.
Es ließ sich rekonstruieren, dass Heinroth durch philosophisches Denken und ganzheitliche Problemlösungsstrategien nicht nur der in seiner Zeit verbreiteten Exkulpationsneigung und der Instrumentalisierung psychischer Erkrankungen entschieden entgegen tritt, sondern auch, wenngleich er dieselben nicht überwindet, dennoch konstruktive Lösungsansätze für forensisch-psychiatrische Debatten findet und damit eine Bereicherung auch für aktuelle neurowissenschaftliche Diskussionen darstellt.
Durch die Tiefendarstellung eines Zeitgenossen wird so ein Beitrag zur Vervollständigung der Geschichte der Forensischen Psychiatrie geleistet.
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Jacob, Jean Daniel. "Fear and power in forensic psychiatry: Nurse-patient interactions in a secure environment." Thesis, Université d'Ottawa / University of Ottawa, 2009. http://hdl.handle.net/10393/32599.
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This research project was situated at the crossroads of two distinct disciplinary fields: nursing and criminology. It sought not only to situate nursing practice in an extreme environment, but also to explore a professional practice in a context where the probability of nurses becoming victims of interpersonal violence is considered to be high, and where fear becomes a perceptible variable that shapes nurse-patient interactions. The goal was to describe and comprehend how fear as a dynamic process influences nursing interactions with patients. This understanding of the relationship between nurses and patients required that fear, the central concept in this project, be examined within the context of the total institution where nurses are both objects and subjects of power. To accomplish this, a qualitative design, which incorporates explorative and descriptive attributes, was thought to be an appropriate choice for this research project. Given the embryonic state of research regarding fear in forensic psychiatric nursing, and given the nature of the research question, grounded theory was considered to be the research method of choice for this project. Once the methodological groundwork was completed, introduction into the research setting permitted the direct observation of nursing routines as well as the completion of eighteen (18) semi-structured interviews. In keeping with an inductive methodological framework, the analysis of the data produced four mutually exclusive categories: 1.) Context, 2.) Nursing Care, 3.) Fear, and 4.) Othering. The fourth category (Othering) that emerged from the data analysis is the core category, because it is the site of a basic social process, and represents the site where all other categories converge. In brief, the results from this research indicate that the environment in which nurses practice is extremely constraining. Within this highly regimented context, nurses are socialized to incorporate representations of the patient population as being potentially dangerous, and, as a result, distance themselves from idealistic conceptions of care. In effect, the heightened awareness and suspicion that a few patients may evoke creates an environment in which trust is difficult to develop. Moreover, the research results emphasize the implication of fear in nurse-patient interactions and particularly how fear reinforces nurses' need to create a safe environment in order to practice. A constant negotiation between space, bodies and security takes place where nurses are forced to scrutinize their actions (self-discipline) in order to avoid becoming a victim of violence. As a result, security is a factor that needs to be present in order for care to be provided. If the environment is considered to be unsafe, then interventions to secure the space are inevitable. In parallel, participants also described how being able to identify with patients enabled positive (read ''therapeutic'') interventions to take place. Casting the patient in the role of the other (sick and/or vulnerable) enabled the nurse to create a rapport with the patient and to use the relationship in a transformative way (self-governance). However, exposure to the patient's criminal history, as well as the inability to rationalize the patient's behaviours within a sickness model, fostered a negative differentiation process wherein nurse-patient interactions became difficult. Along these lines, demonstrating "potential" was also described as an essential motivator for nurses to invest themselves in therapeutic relationships. The tension generated by (a)potential individuals disrupts the normal nursing process, because nurses experience difficulty in finding meaning in nursing care. Finally, participants also highlighted the presence of gender dynamics and social norms that implicitly and explicitly governed work divisions and the presentation of the self in the forensic psychiatric units. Incorporating the masculine standards (being fearless) was seen as a socially desirable attribute. Overall, this research project suggests that the need for safety (both at the individual and collective levels) will always cast a dark shadow over the ideals of care. When nurses feel threatened, security will take precedent over care.
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Swart, Barbour Tania. "The therapeutic alliance as a component of risk management and assessment in forensic mental health." Thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/28370.
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Background: Few forensic mental health facilities in South Africa use formal risk assessment instruments to monitor risk and recovery of forensic state patients. The study set out to examine the usefulness of the therapeutic alliance as a proxy measure of violent recidivism in a forensic state facility. The study proposed that the nature and strength of the therapeutic alliance is associated with risk of violence in a forensic population and that attachment security is a relevant factor in this relationship. Additional related factors were studied including demographic and contextual data and their influence on the alliance and risk.
Design and method: A quantitative research method was used to sample both inpatients and outpatients (n=131) using a naturalistic, cross-sectional research design. Statistical analyses focussed on regression modelling and addressed mainly the statistical associations between ratings of the different variables. Various psychometric tests were administered and scored and entered into a database. It was hypothesised that a strong (positive) therapeutic relationship measured with the Dual- role Relationship Inventory-Revised (DRI-R) questionnaire is associated with low risk for violence using the Historical, Clinical, Risk Management (HCR-20) scale.
Findings: Essentially there was a direct association between the therapeutic alliance and violent recidivism, that is, men with a strong therapeutic alliance have lower risk for violent behaviour. Key practitioner type was considered to be highly influential in establishing positive alliances and as a mediator of potential violent recidivism. An insecure attachment style was dominant in the study sample and insecure states of mind partially influenced current therapeutic alliances with an associated increased vulnerability for violence. Positive psychotic symptoms remained a high-risk factor for violence and criminal histories and antisocial behaviour may continue to present a risk for recidivism in the absence of psychosis.
Conclusion: Violent recidivism can be adequately monitored by the DRI-R. Affiliation and control are not mutually exclusive in forensic mental health care. Addressing attachment deficits prevalent in this population may be useful in informing both risk and recovery. Symptom reduction remains an important aim in treatment and risk management. Ratings of the alliance by practitioners and how it concurs with risk is an area for further research.
Key words: Therapeutic alliance, dual-role relationship, risk assessment, violence, attachment, state patients, recovery
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Finlay-Carruthers, Gemma. "Experiences of family members of adult children in forensic services and their interactions with mental health professionals." Thesis, University of Nottingham, 2016. http://eprints.nottingham.ac.uk/33263/.
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The importance of family caregiver involvement in (secure) mental health services has been increasingly recognised and there is a wide consensus that family caregivers should be seen by clinicians as partners in the care of patients (Harvey & Ramsay, 2004). Mental health carers however, especially those caring for relatives who are subject to compulsory care and treatment, often feel overlooked and marginalised, caring in complex circumstances with little or no support. This thesis focuses specifically on the views and experiences of parents of adult children in forensic mental health services. A structured review and synthesis of qualitative studies was undertaken to develop insight into the perceived level of involvement in care, from the perspective of family members of mental health service users. The review also examines family carers’ relationships and engagement with mental health professionals. This highlighted that the practices of some professionals contribute to the distress experienced by caregivers in this marginalised group. The empirical research study, employed a qualitative design conducted within the framework of IPA, and explored what it is like for parents with an adult son or daughter with mental illness and offending background detained in a regional medium secure unit. Findings indicated that parents’ experiences were characterised by a strained relationship with mental health services, accompanied by practical difficulties in getting help in the first place, and conflicting emotions felt in response to their unwell family member’s continued detention in the forensic care setting. Following on from this, a case study describes brief family psycho-education in secure care and illustrates how staff in forensic services can collaborate with parents more empathetically and effectively. Afterwards, the Family Relations Test, an instrument that assesses affective relations from the child’s perspective is critically reviewed. The utility of this tool in clinical practice is remarked upon. In the concluding chapter, the ways in which service delivery and research can be influenced by ‘giving a voice’ to parents of forensic clients is explored, and implications of the findings are discussed with reference to the current recognition of family and social inclusion.
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Lindstedt, Helena. "Daily occupations in mentally disordered offenders in Sweden : exploring occupational performance and social participating /." Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-6231.
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Bruwer, Marise. "Characteristics of domestic homicide perpetrated by persons with severe mental illness - a forensic psychiatry observation population-based study." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/27454.
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Background: Domestic homicide (killing of a person aged 16 or older by a family member or a current or former partner) accounts for 50% - 70% of homicides perpetrated by offenders with mental illness. Despite these statistics, surprisingly little is currently known about the characteristics of domestic homicides perpetrated by those with severe mental illness. To the best of our knowledge, domestic homicide in the context of severe mental illness has not been researched in South Africa. Objective: To investigate domestic homicides by offenders with severe mental illness referred to the Forensic Mental Health Service at Valkenberg Hospital for forensic psychiatric observation. Methods: A five-year retrospective folder review was conducted to obtain data on the characteristics of offenders and victims, as well as the circumstances surrounding the homicide. Results: The majority of the offenders in our sample were young (mean age of 31), single, unemployed males who were known to mental health care services. Substance use disorders and non-adherence to medication were common. Psychotic disorders were the most prevalent diagnoses. The majority of victims were male and a significant minority of the domestic homicides were parricides (28.6%). The incident took place at the victim's residence or the victim and perpetrator's shared residence in most cases. Stabbing was the most common method used. Almost half of the perpetrators were psychotic when the incident took place and 60% of these were first episode psychoses. In spite of the high prevalence of substance use disorders (66.7%), only 23.8% of the sample reported that they were intoxicated when they committed the offence. Conclusions: The majority of our sample was known to mental health care services. This implies that there were potential missed opportunities to prevent these lethal assaults. Our research identified treatment adherence, comorbid substance use disorders and aggressive treatment of first episode psychosis as a possible focus of future interventions in order to prevent domestic homicides due to mental illness.
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Ryan, Rebecca G. "Assessment of a novel interview technique for improving young children's forensic reports." Morgantown, W. Va. : [West Virginia University Libraries], 2004. https://etd.wvu.edu/etd/controller.jsp?moduleName=documentdata&jsp%5FetdId=3607.
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Thesis (M.A.)--West Virginia University, 2004.Title from document title page. Document formatted into pages; contains viii, 76 p. : ill. Includes abstract. Includes bibliographical references (p. 40-43).
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Mungly, Shazia. "The Prevalence Of Metabolic Disorders And Their Associated Risk Factors In Forensic Patients With Schizophrenia Spectrum Disorders On Clozapine Compared To Haloperidol At Valkenberg Hospital." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/31076.
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Background: Various studies have shown that people with serious mental illness have an increased risk for metabolic syndrome with prevalence ranging from 28.7% to 60%. Given the amount of evidence suggesting a link between clozapine and metabolic syndrome, several guidelines have recommended regular clinical monitoring of metabolic syndrome in patients on clozapine. Aim: To determine the screening, prevalence and associated risk factors of metabolic disorders in forensic patients with schizophrenia spectrum disorders who are on clozapine (study group) compared to patients on haloperidol (control group). Methods: It is a retrospective, folder review of forensic male adult patients at Valkenberg Hospital, Observatory Cape Town. Results: There were 45 patients in the study group and 23 patients in the control group. Eight patients (17.8%) in the study group (Clozapine) met criteria for metabolic syndrome according to the NCEP-ATP III criteria and none of the patients in the control group (Haloperidol) did (χ 2 (1) = 4.441, p = .035 V = .257). Patients who had a diagnosis of schizoaffective disorder were also on mood stabilisers in addition to clozapine. Again, while none of the patients on Haloperidol met the criteria for Metabolic syndrome, 6 (24%) of the 25 patients on concurrent Clozapine and sodium valproate did, (χ 2 (1) = 6.051, p = .023 V = .359). In terms of metabolic disorders, a significantly higher proportion of patients in the study group has hypertension and hyperlipidaemia (p = .003 and p = .021 respectively). Less than 25% of all patients were fully screened for metabolic syndrome. There was a very low rate of screening of blood tests: fasting glucose, total cholesterol, trigylcerides, High Density Lipoprotein(HDL) or Low-Density Lipoprotein (LDL). Conclusion: The prevalence of metabolic syndrome was higher in the clozapine group than haloperidol group, which is unsurprising since clozapine is usually associated with a higher risk of metabolic syndrome. However, the prevalence on metabolic syndrome in this study sample was relatively low compared to other studies. This could be due to the low rate of screening of each criteria of metabolic syndrome. Screening for metabolic syndrome should be regularly performed by health professionals in patients with serious mental illness. Further studies are needed to investigate the risk of metabolic syndrome for patients who are on a combination of clozapine and mood stabilisers.
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Domingue, Jean-Laurent. "Exploring the Production of “Dangerous Persons” in Forensic Psychiatry: A Critical Ethnography of the Ontario Review Board (ORB)." Thesis, Université d'Ottawa / University of Ottawa, 2021. http://hdl.handle.net/10393/42688.
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Forensic psychiatric nursing is a specialty at the junction of two well-researched intersecting systems with two different mandates: criminal justice (public protection) and health care (public good). Nurses’ involvement at one of the systems’ points of juncture, review board (RB) hearings, has largely been left unexplored. At RB hearings, a panel of legal and health care professionals determines if persons unfit to stand trial (UST) or not criminally responsible on account of mental disorder (NCRMD) represent significant threats to the safety of the public, and orders conditions aimed at keeping the community safe. The aim of this research project was to explore how psychiatric and public safety discourses construct the identity of persons UST or NCRMD during RB hearings, and nurses’ contribution to such identity construction. Critical ethnography methodology was employed, mobilizing three data sources: interviews with forensic psychiatric nurses, observations of RB hearings, and RB documentary artifacts. A poststructuralist lens was used to discern how RB culture produces truths about persons UST or NCRMD that sustain the hegemony of public safety and psychiatric discourses. The main finding was that the forensic psychiatric structure leverages therapeutic nursing interventions and documentation as evidence of deviancy, so that persons UST or NCRMD can be objectified and produced as dangerous, prior to socially rehabilitating them. Discursive structures sustaining the forensic psychiatric system inscribe nursing care within a disciplinary scheme, rendering it coercive and punitive. Thus, a care-and-custody dichotomy is insufficient to explain the complex processes at play in forensic psychiatry. These findings have implications for research, practice, and education in forensic psychiatric nursing, nursing ethics, and other nursing specialties on the medico-legal borderland.
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Maharaj, Avani. "A retrospective audit comparing state patients with schizophrenia and bipolar mood disorder who have committed violent crime admitted to the male forensic unit at Valkenberg Hospital." Master's thesis, Faculty of Health Sciences, 2018. http://hdl.handle.net/11427/31140.
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Background
There is a consensus that psychosis confers a modest risk toward violent offending. Most research to date has shown that a statistical relationship does exist between schizophrenia and bipolar disorder, and violence and aggressive behavior In forensic mental health, state patients are rehabilitated in a general program regardless of diagnosis. It is not known whether different rehabilitation management strategies should be implemented on those with bipolar disorder as compared to those with schizophrenia. This study is an attempt to ascertain if there are differences between those diagnosed with schizophrenia and bipolar disorders, and if so, whether these have implications for their rehabilitation programs. Objectives
The study aims to compare the demographic profiles and comorbidities (in terms of substance use and personality disorders) of state patients with bipolar disorder and schizophrenia who have offended violently.
Methods
This was a quantitative, cross sectional study. State patients who were diagnosed with schizophrenia and bipolar disorder and committed a violent crime were included in the study from the 1st January 2000 to 31st December 2014. The study population comprised a total of 93 male state patients. Of these 46 patients had a diagnosis of bipolar disorder and 47 patients had a diagnosis of schizophrenia.
Results
The results show that in general the differences between the schizophrenia group and the bipolar disorder group are marginal. A higher percentage of patients with schizophrenia committed murder at 17.02% and attempted murder at 12.77%. The bipolar disorder group had a significantly higher number of patients diagnosed with co morbid personality disorder at 59.57% (p value of 0.01.) Substance abuse was common in both groups. The mean age at admission was 31,23 years in schizophrenia and 36,85 years in bipolar disorder. This demonstrates an earlier onset of criminality in the group with schizophrenia. Patients with bipolar disorder were more likely to be married (13.04%), divorced (10.8%) or separated (2.17%).
Conclusion
There were no major differences elicited between the 2 groups of patients. Certain aspects such as therapeutic programs for personality disordered patients and social interventions in patients with poor social support would contribute to improving the quality of the rehabilitation programs currently used. The commonalities found in the 2 groups suggest that a common approach to rehabilitation would be adequate in this setting.
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Hammarström, Lars. "Encounters with patients in forensic inpatient care : Nurses lived experiences of patient encounters and compassion in forensic inpatient care." Licentiate thesis, Mittuniversitetet, Institutionen för omvårdnad, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:miun:diva-39955.
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Background: Forensic psychiatry is characterised by compulsory care and long hospital stays, where nurses care for patients with severe mental illness, who often have committed crimes. The main objective is to rehabilitate the patient to once again become a part of society by improving mental health and decreasing the risk of criminal relapse. This is mainly achieved through encounters with the patients. Encountering patients in forensic psychiatry means coming face to face with suffering and the duality of caring, doing what is best for the patient and protecting society. Aim: The purpose of the study was to obtain a deeper understanding of encounters with patients with mental illness in forensic inpatient care as experienced by nurses. Method: This licentiate thesis consists of two studies (I, II), both conducted with a qualitative design. A total of 13 nurses working at a forensic psychiatric hospital in Sweden were recruited through a purposive sample to participate in the studies through narrative interviews. Study I was analysed with phenomenological hermeneutics in line with Lindseth and Norbergh (2004) in order to illuminate the lived experience of nurses’ encounters. Study II was a secondary supplementary analysis, which applied hermeneutics in line with Fleming, Gaidys, and Robb (2003) to gain a deeper understanding of nurses’ compassion in forensic psychiatry. The two studies were merged to provide a comprehensive understanding in this licentiate thesis. Findings: Study I illuminated the meaning of nurses’ lived experiences of encounters with patients with mental illnesses in forensic inpatient care, that is the nurses’ desire to do good despite being confronted with their own emotions as fear, humiliation, and disappointment. Encounters were also occasionally perceived as positive, awakening emotions of compassion, competence, pride, trust, satisfaction, and gratification regarding the patient’s recovery. However, a source of conflict was the struggle between doing what was best for the patient and protecting society. The study comprised of four themes: being frustrated, protecting oneself, being open-minded, and striving for control. Study II aimed to gain a deeper understanding of nurses’ compassion in providing forensic psychiatric inpatient care with three themes: recognising suffering and need for support, responding to patient suffering, and reacting to one’s own vulnerability. Abstracting to a main theme of being compassionate in forensic psychiatry which is described as an emotional journey, an ongoing inner negotiation between own vulnerability and expressions of suffering. This inner negotiation of making sense of patients’ plea and how they were perceived was crucial for determining the development of compassion rather than turning to control and rules as a means to protect oneself. Discussion: A interpretation of the studies (I, II) revealed two topics, being sensitive and responsive and keeping distance, which were reflected upon against the theoretical framework of Kari Martinsen. The studies showed that nurses faced a variety of encounters that forced them to face their own vulnerability and that trust could reduce power imbalances as well as help deal with societal, man-made constructs. The nurses’ encounters with incomprehensible expressions of suffering also show that nurses need to find a way to make room for “expressions of life”– taking a step back and turning their gaze inwards – in order to regulate their own emotions. This may better equip nurses to encounter patients with compassion and kindness rather than turning to norms and rules to protect themselves and guard their own vulnerability. Rather than distancing themselves from the patients, nurses can instead take a step back to come closer to their patients.
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Andersson, Liselotte, and Päivi Jakum. "Inte som i Gökboet : sjuksköterskors beskrivningar av omvårdnadsprocessen inom den rättspsykiatriska vården : en kvalitativ studie." Thesis, University West, Department of Nursing, Health and Culture, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:hv:diva-1564.
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Forensic psyhiatric care protects the society by giving patients care to diminish risks of serious crimes. In their work the nurses use different care methods to help and support the patient in managing his or her life situation. To clarify how a group of nurses describe the nursing process in forensic psychiatric care. A qualitative study based on interviews. Six nurses were interviewed about their work in four different forensic psychiatric care units. The nursing process in is divided into four categories: evaluation, planning, implementation and assessment. The results are based on the way the interviewed nurses described the essential roles of nurse-patient relationship and structured routines in nursing process. The study also shows some specific difficulties in nursing work, for example the mental dysfunctions of patients, the level of competence among staff and the patients need for social interaction and existence beyond their specific needs.
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Astolfo, Therese Ann. "Attitudinal predictors in a Negligence Case." FIU Digital Commons, 1991. http://digitalcommons.fiu.edu/etd/1057.
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This study addresses the use of attitude and personality variables as predictors of compensation and award in a personal injury suit. Safety seeking behavior and attitudes toward tort reform are introduced as case-specific factors that may predict this verdict decision. Two hundred registered voters were surveyed on scales measuring attitudes toward safety, tort reform, and psychiatrists. Subjects also indicated their demographic characteristics and the degree of compensation and amount of award they would render the plaintiff in a civil suit. Results indicated attitudinal variables were more predictive of compensation and award than were demographic variables. The implications of these findings are discussed.
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Jansen, Krista. "Should we always look on the bright side of life? : the role of protective factors in forensic risk assessment and management." Thesis, University of Nottingham, 2017. http://eprints.nottingham.ac.uk/42909/.
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This thesis will aim to identify the role of protective factors in clinical risk prediction and management of inpatients in secure services. Chapter one provides an introduction to the field of forensic risk assessment, and a justification for the importance of including protective factors to create a more balanced assessment of patient risk. Chapter two presents a systematic review exploring the role of protective factors in various risk assessment tools. The aims of this review is to identify risk assessment tools that incorporate a measure of protective strengths, and the predictive validity of these tools for the outcome of inpatient aggression or violence. Chapter three provides a critical review of the START, specifically focused on its strengths and weaknesses as a risk prediction tool, demonstrating good validity, reliability, in addition to excellent inter-rater reliability. Findings will be reported in terms of the clinical utility of this tool. Chapter four presents the findings from a research project that aimed to identify the predictive validity of the START in female forensic inpatients, highlighting the efficacy of the specific risk estimates. Chapter five utilises a case study to identify how promoting protective factors in the form of coping skills can reduce self-harming behaviours. This case study aims to demonstrate that focusing treatment on promoting patient strengths can be effective in reducing adverse outcomes. Finally, chapter six discusses the overall findings and clinical implications from the present thesis. Future research directions will also be discussed.
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Nordström, Annika. "Violent offenders with schizophrenia : quantitative and qualitative studies focusing on the family of origin." Doctoral thesis, Umeå universitet, Psykiatri, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-298.
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The focus of the thesis is on violent offenders with schizophrenia and their relatives. The aims were to explore incidence of violent crimes, the extent to which family members were victims, to investigate individual background factors among violent offenders, and to identify psychotic symptoms and triggering factors associated with fatal violence. In addition, parents were interviewed to build an understanding of their experiences and emotional reactions. One study examined all 369 male individuals who had committed a violent crime (assault, homicide or attempt to any of these crimes), who in a pre-trial forensic psychiatric evaluation (FPE) during 1992-2000 were diagnosed with schizophrenia, and who were referred to forensic psychiatric treatment. Although the majority of the 615 victims was unacquainted to the offenders, family members or male acquainted were most at risk of being severely injured or killed as victims. Background factors were studied for the 207 Swedish offenders who for their first time were subjects of a FPE during the study period. There were indications that those offenders who targeted family members had an earlier onset and more severe course of their mental illness. During the study period, 48 offenders committed homicides. Of the 52 victims, 83% were family members or acquainted to the offender. Those who killed a family member had more often delusions and/or hallucinations, were less often intoxicated, had to a lesser extent committed a previous violent crime and they were younger at the time of the homicide. Parents, who were interviewed, were very emotionally involved in their adult sons, although they were not living together. Ignorance regarding the diagnosis of their son and his criminality negatively influenced the contacts, both between parent and son and between parent and professionals in psychiatry. However, the referral to forensic psychiatric treatment gave the parents hope for a positive development.
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Pedraza, Otto. "On the latent structure of cognitive malingering a multivariate taxometric analysis /." [Gainesville, Fla.] : University of Florida, 2004. http://purl.fcla.edu/fcla/etd/UFE0006261.
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Thesis (Ph.D.)--University of Florida, 2004.Typescript. Title from title page of source document. Document formatted into pages; contains 122 pages. Includes Vita. Includes bibliographical references.
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Wallengren, Kristin B. "Mental disorder labelling as an extralegal variable in mock jury deliberations." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2004. https://ro.ecu.edu.au/theses/825.
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Previous research has shown that a number of characteristics of trial participants (extralegal variables) can and do influence juror’s judgements. This is of importance as only the legally relevant facts of the case should be considered during a trial. The present study investigates the influence of victim characteristics on the juror decision making process during deliberation and the judgements made about the victim, crime and defendant in a mock jury setting, as well as investigating mock juror gender differences. A representative sample of people eligible for jury duty in Western Australia viewed a video vignette depicting a trial, in which the mental disorder label (no label, schizophrenia, depression, intellectual disability) was varied. Deliberations were videotaped and subject to an analysis in conjunction with pre and post test questionnaire measuring victim characteristics. A 4x2x2 repeated measures ANOVA was used to analyse the data, in addition to the analysis of the deliberations. The qualitative findings suggest that mock jurors invested relatively much time in some mental disorder labels may function as extralegal variables. This inference is supported by the quantitative findings in this study. The mental disorder label assigned to the victim had an impact on mock jurors’ perception of the likeability, reliability and honesty of the victim, the responsibility for the crime and the guilt of the defendant, often interacting with mock juror gender and deliberation. However, no clear pattern of bias against or in favour of any specific victim could be discerned. There was slightly more evidence of a negative bias than a positive bias towards the no label and schizophrenia victims, while the opposite was true for the depression and intellectual disability victims.
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Hörberg, Ulrica. "Att vårdas eller fostras. Det rättspsykiatriska vårdandet och traditionens grepp." Doctoral thesis, Växjö universitet, Institutionen för vårdvetenskap och socialt arbete, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:vxu:diva-1943.
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To be sentenced to care in the forensic psychiatric services can be seen as one of the most comprehensive encroachments society can make on a person's life and being, as it entails a limitation of the individual's freedom but with no time limit. The aim of this dissertation is to describe caring in forensic psychiatry based on how it is experienced by those who perform the caring and by those are cared for in a maximum secure unit. A reflective lifeworld approach, based on phenomenological philosophy, has been applied. The data has been collected in interviews that have been analyzed by use of a meaning analysis searching for the essence of the phenomenon. The results of the research are presented in two empirical studies and a general structure based on the empirical findings. The dissertation also contains an excursus, a philosophical intermediate chapter containing further analysis of the results of the studies. The results show how the forensic psychiatric care is experienced as being non-caring by the patients with only small "pockets" of good care. Caring consists of corrective techniques that are unreflected and contradictory, where the conditions are determined by the caregivers and the ward culture. The correcting takes place through the modification of the patients' behaviour with the aim of the patients having to adapt themselves to the terms of the care provision. This care results in the patients trying, by use of different strategies, to adapt them-selves to the demands of the caregivers in order to gain privileges. At the same time the patients long to get away from the care system and are lacking real, meaningful and close relationships. To be the subject of care entails struggling against an approaching overwhelming sense of resignation and to care entails experiencing both power and powerlessness in performing the care. A destructive power struggle is being waged within forensic psychiatric care that suppresses the caring potential and true caring is thus elusive. The characteristics of forensic psychiatric care, based on the results of the research, are clarified in the dissertation's excursus. These include the corrective and disciplinary nature of forensic psychiatric care, its power and how this is materialized in care situations as well as the influence of tradition on current forensic psychiatric care in the light of the work of the French philosopher Michel Foucault. The dissertation shows that if the caring potential is to be able to be developed and form a caring nucleus for forensic psychiatric care then education levels need to be further developed. A caring culture and caring environment is needed where true caring can gain a foothold. In order for this to become a possibility the current caring culture and environment must be clarified, questioned and examined. The prevalent fundamental ideas in forensic psychiatric care have to be "jeopardized" and challenged by new scientifically based ideas on what constitutes true caring in this context.
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Singh, Jay. "Forensic risk assessment : a metareview, novel meta-analysis, and empirical study developing a violence screening tool for schizophrenia." Thesis, University of Oxford, 2011. http://ora.ox.ac.uk/objects/uuid:c5f818ea-8e76-4aef-9716-83a4e74eb9bf.
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Mental health professionals are routinely called upon to assess the violence risk of their patients. An increasingly common method for conducting such assessments is the use of structured risk assessment tools. The aim of this thesis was to investigate the utility of such instruments: to identify and explore current uncertainties concerning their applicability and to design a novel measure that could be used as part of a stepped strategy to risk assessment. Though a number of risk assessment tools have been developed and there is a considerable literature concerning their psychometric properties, uncertainty remains regarding their effective use. In order to identify key contemporary uncertainties, a metareview of the forensic assessment literature was conducted. The metareview found that previous systematic reviews and meta-analyses of the risk assessment literature have come to conflicting conclusions on a number of issues, including the comparative predictive validity of risk assessment tools, the efficacy of actuarial tools versus clinical judgement, and the influence of demographic factors and study design characteristics on predictive accuracy. These uncertainties were then investigated in a comprehensive meta-analysis of nine commonly used risk measures. The meta-analysis concluded that there were significant differences between the predictive validity of the risk assessment tools, with instruments designed for more specific purposes performing better than those designed for more general use. Tools performed best when administered to samples demographically similar to their calibration sample. Actuarial instruments and structured clinical judgement were found to perform comparably. The final study presented in this thesis explored the feasibility of a stepped approach to risk assessment in which individuals at very low risk of future violence are screened out prior to resource-intensive clinically based assessment. High-quality national registers were used to construct a simple tool to identify patients with schizophrenia at very low risk of violent conviction after being discharged from hospital. The tool was found to produce high rates of sensitivity as well as high negative predictive values at 1, 2, and 5 years follow.up. In light of the findings of these three studies, risk assessment procedures and guidelines by mental health services and criminal justice systems may need review.
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Stinson, Jill D., and Michael D. Clark. "Motivational Interviewing with Offenders: Engagement, Rehabilitation, and Reentry." Digital Commons @ East Tennessee State University, 2017. https://www.amzn.com/1462529887.
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From experts on working with court-mandated populations, this book shows how motivational interviewing (MI) can help offenders move beyond resistance or superficial compliance and achieve meaningful behavior change. Using this evidence-based approach promotes successful rehabilitation and reentry by drawing on clients' values, goals, and strengths--not simply telling them what to do. The authors clearly describe the core techniques of MI and bring them to life with examples and sample dialogues from a range of criminal justice and forensic settings. Of crucial importance, the book addresses MI implementation in real-world offender service systems, including practical strategies for overcoming obstacles.https://dc.etsu.edu/etsu_books/1135/thumbnail.jpg
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Lobo, Heraldo Guedis. "AnÃlise dos casos de suicÃdio ocorridos em fortaleza no ano de 2007: abordagem farmacolÃgica e psiquiÃtrico-legal." Universidade Federal do CearÃ, 2009. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=4300.
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nÃo hÃAnÃlise dos casos de suicÃdio ocorridos em Fortaleza no ano de 2007: Abordagem FarmacolÃgica e PsiquiÃtrico-Legal. A problemÃtica do suicÃdio deve ser analisada sob o ponto de vista mÃdico psiquiÃtrico amplo e realista. VÃrias pesquisas sÃo desenvolvidas com o propÃsito de identificar caracterÃsticas associadas a indivÃduos que cometem suicÃdio, bem como seus fatores de risco. Acredita-se que o suicÃdio deve ser analisado como um ato complexo, arrolado por diferentes variÃveis, desde aspectos genÃticos atà aspectos psicolÃgicos, psiquiÃtricos e socioculturais, portanto, estando os suicÃdios ligados a vÃrios fatores de risco, à preciso diagnosticar precocemente os portadores de qualquer alteraÃÃo psÃquica, como tambÃm se faz necessÃrio que a psiquiatria forense esteja capacitada para identificar a saÃde mental dos suicidas por meio de autÃpsias psicolÃgicas para servirem de prova em questÃes judiciais. Algumas das alteraÃÃes associadas ao suicÃdio sÃo depressÃo, alcoolismo, transtorno de personalidade e condiÃÃes mÃdicas gerais, entre outras. Tendo em vista que o suicÃdio vem se apresentando como um problema de saÃde pÃblica em diversos paÃses, torna-se necessÃrio analisar as condiÃÃes implicadas em tal fenÃmeno para coleta de dados no intuito de criar estratÃgias para a prevenÃÃo e tratamento das causas desencadeadoras de tal ato. Esta dissertaÃÃo analisa os casos de suicÃdios ocorridos em Fortaleza, no ano de 2007: Abordagem FarmacolÃgica e PsiquiÃtrico-Legal e defende a necessidade de investir no tratamento neuropsicofarmacolÃgico de todos os indivÃduos portadores das enfermidades mentais que possam levar o suicÃdio.
The issue of suicide should be analyzed from a broad and realistic psychiatric medical point of view. Several researches have been developed in order to identify characteristics associated with individuals who commit suicide and its risk factors. There is a belief that suicide must be analysed as a complex act, enrolled by different variables, from genetic to psychological, psychiatric and socio-cultural aspects, therefore, suicides are linked to several risk factors, it is necessary to diagnose early those individuals who present any psychic alteration. It is also necessary that suicidal forensic psychiatry can be able to identify the mental health of suicide through psychological autopsies in order to use the results as evidences in legal questions. Some of the alterations associated to suicide are: depression, alcoholism, personality disorder and general medical conditions, among others. Considering that suicide is reported as a public health problem in many countries, it is necessary to analyze the circumstances involved in this phenomenon for data collection in order to develop strategies for prevention and treatment of precipitating causes of such an act. This thesis examines the cases of suicides in Fortaleza, in the year 2007: Pharmacological and Legal Psychiatric Approaches, and defends the need for investing in Neuropsychopharmacology treatment of all individuals with mental illnesses that could lead to suicide.
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LeMay, Carrie. "Impact of Adverse Childhood Experiences on Mental Health Outcomes and Related Prescription Practices in a Psychiatric Inpatient Sample." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etd/3636.
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A definitive association between adverse childhood experiences (ACEs) and negative physical and mental health outcomes has been established. There is evidence that individuals in forensic psychiatric facilities are disproportionately exposed to ACEs, which may impact severity, prognosis, and age of onset of psychiatric symptoms, including behavioral concerns of institutional aggression, self-harm behaviors, and suicide attempts. Such psychiatric and behavioral concerns are often managed through multiple psychotropic prescriptions, leading to psychotropic polypharmacy. This study evaluated the relationship between ACEs, mental health and behavioral concerns, and psychotropic polypharmacy through analysis of archival data from a forensic inpatient psychiatric facility. A total of 182 patients met inclusion criteria. Through a comprehensive record review, ACE scores, mental health outcomes, behavioral concerns, and prescription practices were ascertained and subjected to a series of regression analyses. Results indicate that the current participants experience greater prevalence of ACEs and mental health outcomes, as well as higher rates of psychotropic polypharmacy. These relationships are mediated by history of self-harm behaviors. The higher polypharmacy rates yield greater negative side effects with the need to manage with additional medications. Taken as a whole, ACEs are a relevant consideration, as childhood adversity may lead to a lifetime of difficulty with managing emotional distress and symptoms of psychopathology. Pharmacological treatment may be necessary, particularly with those who experience more complex mental health outcomes. However, a primary focus on psychotropic intervention can result in high rates of medications and polypharmacy with significant side effects. Incorporation of non-pharmacological intervention should be a primary consideration with forensic inpatients to circumvent the potential for psychotropic polypharmacy and related negative consequences.
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Helker-Nygren, Joel, and Joel Evermark. "Comparing threat and physical violence perpetrated towards staff between two forensic settings : a cross-sectional study." Thesis, Mittuniversitetet, Avdelningen för samhällsvetenskap, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:miun:diva-31971.
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This study was conducted within two forensic settings, the high security correctional facility Saltviksanstalten, and the forensic psychiatric institution Karsudden hospital. 66 staff members from Saltvik and 39 from Karsudden participated by answering a questionnaire about threat and physical violence perpetrated towards them by inmates/patients. The aim of the present study was to analyze and compare the prevalence of threat and physical violence and related factors perpetrated by inmates/patient towards staff within these two forensic settings with the objectives to compare and analyse the prevalence, characteristics, situations and consequences of the threat and physical violence. The results showed that a higher percentage of participants were exposed to threats and physical violence within the forensic psychiatric setting. As regards to the intentions behind the threats and physical violence, inmates within high security correctional facilities was to a higher degree instrumental whereas patients within the forensic psychiatry showed a higher degree of reactive intentions. The conclusion is that victimization in the form of threat and physical violence is comprehensive, especially within the forensic psychiatry. Due to that victimization increases both the risk of revictimization, and have a number of negative personal- and societal consequences, this is an issue that needs to be highlighted in order to improve both the work environment and the mental health for the staff.2017-06-01
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Sturup, Joakim. "En rättspsykiatrisk populationsstudie över tid." Thesis, Stockholm University, Department of Social Work, 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-904.
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Uppsatsen syftar till att ge en allmän beskrivning av den grupp som kommer till rättspsykiatrisk undersökning samt att utreda gruppens förändring över en period på sju år. Variabler som behandlas är kön, invandrarbakgrund, diagnos, brott och påföljd. Uppsatsen som är en kvantitativ studie, kan ses som ett inlägg i debatten kring den allvarligt psykiskt störda brottslingen.
Uppsatsen är en retrospektiv registerstudie utifrån ett medicinskt kriminologisk perspektiv. Materialet består av 4466 stycken rättspsykiatriska undersökningar mellan åren 1998 och 2004 och inhämtades från Rättsmedicinalverkets centrala arkiv. I resultatet framkommer att personlighetsstörningar i allt mindre utsträckning anses utgöra en allvarlig psykisk störning. Samtidigt blir de allt mindre frekventa som diagnoser inom gruppen. Psykossjukdomar är de diagnoser som i högst utsträckning anses utgöra en allvarlig psykisk störning. Kvinnor bedöms i en klart högre utsträckning än män lida av en allvarlig psykisk störning. Det förekommer ingen skillnad mellan svenskar och invandrare i bedömningen av allvarlig psykisk störning. Dock diagnostiseras invandrare oftare med psykosdiagnoser samt skattas att fungera sämre enligt GAF-skalan. Våldsbrottens andel bland de undersökta har ökat. Dock utgörs det främst av en ökning i hot och misshandel och kan inte påvisas vara relaterat till en ökning i dödligt våld.
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Sjöstedt, Gabrielle. "Violent recidivism among sexual offenders : risk factors and assessment procedures /." Stockholm : [Karolinska institutets bibl.], 2002. http://diss.kib.ki.se/2002/91-7349-328-7/.
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Södrup, Alexander, and Hanna Lorentzson. "Motiverande Samtal i Rättspsykiatrin : Kvalitativ studie av skötarens upplevelse av att arbeta med MI i rättpsykiatrisk arbetsmiljö." Thesis, Linnéuniversitetet, Institutionen för psykologi (PSY), 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-60445.
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Motiverande samtal är en metod som kan användas för att hjälpa individer att finna motivation till förändring. Syftet med föreliggande studie är att undersöka hur skötare inom rättspsykiatrin ser på att använda motiverande samtal inom sitt arbete samt hur de använder sig av metoden. Semistrukturerade intervjuer utfördes med informanter som jobbade aktivt med motiverande samtal på en rättspsykiatrisk klinik. Insamlade data analyserades tematiskt vilket resulterade i fem huvudkategorier med grenade underkategorier. Dessa kategorier visade att informanterna använde sig av både riktade motiverande samtal samt använde metodens förhållningssätt utanför dessa samtal. Majoriteten av informanterna uttryckte sig positivt om metoden, med en vilja att fortsätta lära sig om metoden, samt att de gärna ser att fler medarbetare börjar arbeta med metoden. Personlighet uppfattades vara en faktor som inverkade på uppfattad svårighetsgrad av moment inom motiverande samtal. Inga större brister uppfattades angående motiverande samtal utan det var brister som berodde på arbetsplatsen. De fem huvudkategorierna ansågs ge svar på studiens frågeställningar och dessa svar kan i sin tur hjälpa rättspsykiatrin att utveckla sin verksamhet.
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Södrup, Alexander, and Hanna Lorentzson. "Motiverande Samtal i Rättspsykiatrin : Kvalitativ studie av skötarens upplevelser av att arbeta med MI i rättspsykiatrisk arbetsmiljö Författare:." Thesis, Linnéuniversitetet, Institutionen för psykologi (PSY), 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-60446.
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Motiverande samtal är en metod som kan användas för att hjälpa individer att finna motivation till förändring. Syftet med föreliggande studie är att undersöka hur skötare inom rättspsykiatrin ser på att använda motiverande samtal inom sitt arbete samt hur de använder sig av metoden. Semistrukturerade intervjuer utfördes med informanter som jobbade aktivt med motiverande samtal på en rättspsykiatrisk klinik. Insamlade data analyserades tematiskt vilket resulterade i fem huvudkategorier med grenade underkategorier. Dessa kategorier visade att informanterna använde sig av både riktade motiverande samtal samt använde metodens förhållningssätt utanför dessa samtal. Majoriteten av informanterna uttryckte sig positivt om metoden, med en vilja att fortsätta lära sig om metoden, samt att de gärna ser att fler medarbetare börjar arbeta med metoden. Personlighet uppfattades vara en faktor som inverkade på uppfattad svårighetsgrad av moment inom motiverande samtal. Inga större brister uppfattades angående motiverande samtal utan det var brister som berodde på arbetsplatsen. De fem huvudkategorierna ansågs ge svar på studiens frågeställningar och dessa svar kan i sin tur hjälpa rättspsykiatrin att utveckla sin verksamhet.
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Longhetti, Anthony. "A study to evaluate assessment center exercises and to develop a set of exercises specifically designed to identify managerial potential among professional employees in forensic science laboratories." CSUSB ScholarWorks, 1991. https://scholarworks.lib.csusb.edu/etd-project/835.
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Tina, Hosseini, and Linnea Moberg. "Att främja patienters delaktighet inom rättspsykiatrisk vård : En allmän litteraturöversikt." Thesis, Röda Korsets Högskola, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:rkh:diva-4035.
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Background: Forensic psychiatric care is a non-voluntary care form for people with severe mental disorders and criminal backgrounds. These patients have a restricted autonomy based on predetermined guidelines regulating this careform. The legislation governing forensic psychiatry confines the patient's power to influence the decision making concerning their treatment plan. Enabling patient involvement in this non-voluntary careform can be challenging for healthcare staff. Aim:To identify how patient involvement can be encouraged within forensic psychiatry. Method: A literature overview proceeding from eleven scientific qualitative articles that were analysed using thematic analysis method. Result: The patients stated that they wanted a greater influence over their care form. Furthermore, they lifted the importance of being informed about their treatment plan and medications by the caregivers to increase their involvement. Patients and healthcare staff relations are characterized by honesty and constitute a central role in patient involvement encouragement. Conclusion: Based on the literature study’s result the authors identified two key factors that affect the patients' experience of their involvement negatively, these factors were lack of information and exclusion from treatment conferences. Further research through qualitative studies should be carried out focusing on the working and non-working methods regarding the promotion of forensic psychiatric patients' involvement.Bakgrund: Rättspsykiatrisk vård är en ofrivillig vårdform som personer med en allvarlig psykiatrisk störning som begår ett brott kan dömas till. Patienter inom rättspsykiatrisk vård har en begränsad autonomi vilket grundar sig i förutbestämda riktlinjer som styr denna vårdform. Att möjliggöra patientens delaktighet inom rättspsykiatrisk vård kan vara en utmaning för vårdpersonalen då vården inte utgår från samtycke. Syfte: Att identifiera hur patienters delaktighet kan främjas inom den rättspsykiatriska vården. Metod: En litteraturöversikt som utgick från elva vetenskapliga artiklar med kvalitativ ansats. Artiklarna som inkluderades analyserades med tematisk innehållsanalys. Resultat: Patienterna uppgav att de ville ha större inflytande över den vård de erhöll. Vidare lyfte de vikten av att vårdpersonal gav dem information kring deras behandling och medicinering för att främja deras delaktighet i vården. Vårdrelationen mellan patienter och vårdpersonal präglas av ärlighet och utgör en central roll vid främjande av patienters delaktighet. Slutsats: Utifrån litteraturstudiens resultat identifierade författarparet att två nyckelfaktorer som visades påverka patienternas upplevelse av delaktighet negativt var brist på information och exkludering från behandlingskonferenser. Fortsatt forskning genom kvalitativa studier bör utföras med fokus på de arbetsmetoder som fungerat och inte fungerat gällande främjandet av rättspsykiatriska patienters delaktighet.
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Hosseini, Tina, and Linnea Moberg. "Att främja patienters delaktighet inom rättspsykiatrisk vård : En allmän litteraturöversikt." Thesis, Röda Korsets Högskola, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:rkh:diva-4035.
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Background: Forensic psychiatric care is a non-voluntary care form for people with severe mental disorders and criminal backgrounds. These patients have a restricted autonomy based on predetermined guidelines regulating this careform. The legislation governing forensic psychiatry confines the patient's power to influence the decision making concerning their treatment plan. Enabling patient involvement in this non-voluntary careform can be challenging for healthcare staff. Aim:To identify how patient involvement can be encouraged within forensic psychiatry. Method: A literature overview proceeding from eleven scientific qualitative articles that were analysed using thematic analysis method. Result: The patients stated that they wanted a greater influence over their care form. Furthermore, they lifted the importance of being informed about their treatment plan and medications by the caregivers to increase their involvement. Patients and healthcare staff relations are characterized by honesty and constitute a central role in patient involvement encouragement. Conclusion: Based on the literature study’s result the authors identified two key factors that affect the patients' experience of their involvement negatively, these factors were lack of information and exclusion from treatment conferences. Further research through qualitative studies should be carried out focusing on the working and non-working methods regarding the promotion of forensic psychiatric patients' involvement.Bakgrund: Rättspsykiatrisk vård är en ofrivillig vårdform som personer med en allvarlig psykiatrisk störning som begår ett brott kan dömas till. Patienter inom rättspsykiatrisk vård har en begränsad autonomi vilket grundar sig i förutbestämda riktlinjer som styr denna vårdform. Att möjliggöra patientens delaktighet inom rättspsykiatrisk vård kan vara en utmaning för vårdpersonalen då vården inte utgår från samtycke. Syfte: Att identifiera hur patienters delaktighet kan främjas inom den rättspsykiatriska vården. Metod: En litteraturöversikt som utgick från elva vetenskapliga artiklar med kvalitativ ansats. Artiklarna som inkluderades analyserades med tematisk innehållsanalys. Resultat: Patienterna uppgav att de ville ha större inflytande över den vård de erhöll. Vidare lyfte de vikten av att vårdpersonal gav dem information kring deras behandling och medicinering för att främja deras delaktighet i vården. Vårdrelationen mellan patienter och vårdpersonal präglas av ärlighet och utgör en central roll vid främjande av patienters delaktighet. Slutsats: Utifrån litteraturstudiens resultat identifierade författarparet att två nyckelfaktorer som visades påverka patienternas upplevelse av delaktighet negativt var brist på information och exkludering från behandlingskonferenser. Fortsatt forskning genom kvalitativa studier bör utföras med fokus på de arbetsmetoder som fungerat och inte fungerat gällande främjandet av rättspsykiatriska patienters delaktighet.
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Muñoz, Pedro Felipe Neves de. "Degeneração atípica: uma incursão ao arquivo de Elza." reponame:Repositório Institucional da FIOCRUZ, 2010. https://www.arca.fiocruz.br/handle/icict/6099.
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Previous issue date: 2010Esta investigação histórica da teoria e prática psiquiátrica no Brasil pretende analisar os Estados Atípicos de Degeneração, um grupo de categorias diagnósticas sugerido pela Classificação Psiquiátrica da Sociedade Brasileira de Psiquiatria, Neurologia e Medicina-Legal, em 1910. Para realização deste estudo, selecionamos um caso clínico específico do Pavilhão de Observação, instituição que se localizava no complexo do antigo Hospício Nacional de Alienados, responsável pelo ensino de psiquiatria e triagem de pacientes. Este caso versa sobre uma mulher alemã, denominada em nossa pesquisa de Elza, que se envolveu em uma trama de intrigas que culminou em sua internação no Pavilhão de Observação, em junho de 1925, através da polícia e a pedido do marido, sob a alegação de abandono do lar conjugal, adultério e suspeita de loucura. No Pavilhão, Elza foi diagnosticada como portadora de um estado atípico de degeneração, com síndrome paranóide de interpretação e delírio de ciúmes , conseguindo sair de lá através de um habeas corpus. Nosso principal objetivo é analisar as relações entre gênero, prática psiquiátrica e degeneração atípica, através de uma incursão no arquivo de Elza, caracterizado por uma rede de discursos que articularam disputas por autoridade e verdade entre os diferentes protagonistas do caso. Nesse sentido, seguindo o curso das atipicidades desta história, nós iremos debater as diferenças culturais, questões de classe social, gênero e direitos civis dos homens e mulheres na legislação brasileira e alemã, nas primeiras décadas do século XX.