The Management of Patients with Psychotic Disorders in Forensic Psychiatry

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

Deadline for manuscript submissions: closed (30 April 2024) | Viewed by 1387

Special Issue Editors


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

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

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

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

Special Issue Information

Dear Colleagues,

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

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

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

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

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

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

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

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

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

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

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

Dr. Luigi Cipolloni
Guest Editors

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

Manuscript Submission Information

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

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

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

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

Published Papers (1 paper)

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

Research

13 pages, 325 KiB  
Article
Predictors of Defensive Practices among Italian Psychiatrists: Additional Findings from a National Survey
by Donato Morena, Nicola Di Fazio, Pasquale Scognamiglio, Giuseppe Delogu, Benedetta Baldari, Luigi Cipolloni, Paola Frati and Vittorio Fineschi
Medicina 2023, 59(11), 1928; https://doi.org/10.3390/medicina59111928 - 31 Oct 2023
Cited by 1 | Viewed by 946
Abstract
Background: Defensive medicine is characterized by medical decisions made primarily as a precaution against potential malpractice claims. For psychiatrists, professional responsibility encompasses not only the appropriateness of diagnosis and treatment but also the effects of their interventions on patients and their behaviors. [...] Read more.
Background: Defensive medicine is characterized by medical decisions made primarily as a precaution against potential malpractice claims. For psychiatrists, professional responsibility encompasses not only the appropriateness of diagnosis and treatment but also the effects of their interventions on patients and their behaviors. Objective: To investigate the socio-demographic, educational, and occupational characteristics and work-related attitudes that may serve as predictors of defensive medicine among Italian psychiatrists. This research extends the results of a previous analysis based on a national survey. Methods: A secondary analysis of the database of a national survey on attitudes and behaviors of Italian psychiatrists regarding defensive medicine and professional liability was performed for this study. Results: Among 254 surveyed psychiatrists, 153 admitted to practicing defensive medicine, while 101 had this attitude with less than half of their patients. The first group was predominantly comprised of women (p = 0.014), who were younger in age (43.34 y 9.89 vs. 48.81 y 11.66, p < 0.001) and had fewer years of professional experience (12.09 y ± 9.8 vs. 17.46 y ± 11.2, p < 0.001). There were no significant differences in prior involvement in complaints (p = 0.876) or the usual place of work (p = 0.818). The most prominent predictors for practicing defensive medicine were (1) considering guidelines and good clinical practices not only for their clinical efficacy but also or exclusively for reducing the risk of legal complaints for professional liability (OR = 3.62; 95%CI, 1.75–7.49), and (2) hospitalizing patients with violent intentions even if not warranted according to their mental state (OR = 2.28; 95%CI, 1.50–3.46, p < 0.001). Prioritizing protection from professional liability over patients’ actual needs in prescribing or adjusting drug dosages and in involuntary hospitalization, as well as prescribing lower dosages than recommended for pregnant patients, were identified as additional predictors. Finally, years of professional experience exhibited a protective function against defensive practices. Conclusions: Psychiatrists advocate the need to implement a ‘risk management culture’ and the provision of more balanced duties in order to ensure ethical and evidence-based care to their patients. A particular source of concern stems from their professional responsibility towards not only the health of patients but also their behavior. However, these aspects conflict with a limited potential for assessment and intervention based on effective clinical tools. A reform of professional liability that considers the specificities of patients cared for by mental health services could contribute to reducing the risk of defensive medicine. Full article
Back to TopTop