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Munchausen syndrome by proxy is the most difficult form of child abuse. It carries substantial morbidity and mortality. The diagnosis relies on appropriate suspicion and careful investigation. The psychological illness/need of the perpetrator is the main clinical feature. Early recognition and appropriate intervention prevent further abuse and criminal actions.
Professionals have suggested that aggressiveness, substance abuse, and criminality contribute to poor outcomes after brain injury. There is considerable research regarding post-injury aggressive behaviour, but limited information concerning criminal behaviour and alcohol use patterns. With a sample of 327 patients varying in severity of traumatic brain injury, the present investigation examined alcohol use patterns, arrest histories, behavioural characteristics, and psychiatric treatment histories. Relative to the uninjured population, analysis revealed relatively high incidence of heavy drinking, both pre- and post-injury, among patients with a history of arrest. Increases in abstinence rates were found regardless of arrest history. In addition, a history of arrest was associated with a greater likelihood of psychiatric treatment. Findings also indicated relatively high levels of aggressive behaviours. Discussion focuses on implications for evaluation, rehabilitation, and future research.
There are only scant literature data on reasons and circumstances of medico-legal second autopsies. The present study includes 12 second autopsies from the period 1992-1997; the first post-mortem examination took place either in the home country (institutes of pathology) or abroad. 7 of the 12 cases of death investigated happened in Germany (exclusively in hospitals) and 5 of them abroad (Netherlands, Romania, Portugal, Libya). Repeat autopsies were ordered by criminal courts (n = 9), private persons (n = 2) and social insurances (n = 1). The main indication was possible medical malpractice (n = 6); acts of violence (n = 3), insurance questions (n = 2) and accidents (n = 1) followed. The time lapse between death and second autopsy was 2-35 days. It was striking, that German institutes of pathology had partially performed autopsies despite the certification of a non-natural death. Clinical autopsies were stopped twice, when evidence of a possible non-natural death occurred. It could be fundamentally stated, that first autopsies in German institutes of pathology had been carefully performed and sufficiently documented. In these cases the second autopsy presented no or only little additional information, as far as the broader taking of (toxicological) samples is not considered. The final medico-legal expertise was then mainly based on the findings of the clinical first autopsy. However, the concurrence of the forensic expert (instead of the clinical pathologist) is undoubtedly essential for the evaluation of these issues involving frequently questions of malpractice. By contrast, the quality of postmortems performed abroad varies widely. 4 of the 5 first autopsies done abroad were regarded as completely or partly insufficient with superficial or almost absent preparation of organs or contradictions in the medical reports, respectively. A repeat autopsy is absolutely necessary in such cases. On the whole, the initial question could be answered in all second autopsies at least in part. This emphasizes the high value of second autopsies and expertises, especially in non-natural cases of death (10 of 12 deaths were finally judged as non-natural).
A method for genomic DNA recovery from different types of PCR product mixes suitable for multiplex amplification and typing using the Profiler Plus STR typing system has been investigated. The application of this method is of significance in cases where the original DNA samples have been exhausted due to repeated typing analyses in an effort to maximize their evidentiary value. Such cases typically involve samples analyzed using the available DNA typing systems of the time which gave a markedly lower power of discrimination, either alone or in combination, compared to that of modern multiplex STR typing systems. It was found that an effective method for recovering genomic DNA from HLA-DQA1 +PM and CTT triplex amplification mixes, suitable for reproducible achievement of the complete Profiler Plus profile, involved the use of Amicon Microcon-100 microconcentrators. Interestingly, this method was not required to achieve the complete nine STR profile using D1S80 amplification mixes.
Preventive detention can be ordered, if a person falls back into crime repeatedly and shows a "disposition to commit substantial offences". In the trial and at subsequent points of time expert opinions supporting this personal disposition have to be obtained. However up to now it is not clear on which basis such statements should be made. On the basis of a retrospective investigation of the author's own expert opinions the paper discusses the relevance of Hare's psychopathy concept for opinions on criminal disposition.
Hair testing is only used by the Federal Bureau of Investigation (FBI) when other information exists that indicates drug use and can remove a person from suspicion or associate them with criminal activity. The detection of cocaine in hair has been the FBI's first priority in hair testing for drugs of abuse because of its prevalence. Several cases when hair testing was used are reported in this chapter. Further, analysis of over 100 samples was performed on hair obtained from a medical examiner's random autopsy collection. Sixty-five percent of the samples tested positive for cocaine or opiates. The results of hair testing for drugs of abuse were found to be consistent with autopsy toxicology reports. The analysis of hair washes and nails from the autopsy samples suggests external contamination of hair with drugs is not widespread.
BACKGROUND: The police are the gatekeepers to the criminal justice system (CJS). It is agreed that where possible mentally ill people should be diverted to psychiatric care. The purpose of this investigation was to determine what factors were associated with the entry of obviously mentally ill people into the CJS. METHOD: The population of all detainees arrested in seven London police stations was observed to determine the presence of obvious mental illness. All detainees regarded as ill or known to have significant psychiatric histories were followed through the CJS to court disposal. Defendants diagnosed as psychotic by court liaison psychiatrists were identified and the circumstances of their arrest and detention examined. RESULTS: Of all police detainees observed, 1.4% were found to be acutely ill. Diversion of obviously ill detainees was common practice. The factor most strongly associated with entry to the CJS was the presence of violence at time of arrest. Other factors were the persistence of (petty) offending and the operation of court warrants issued as a result of the person's failure to appear at court when required to do so. CONCLUSIONS: Both police and courts are well aware of the inappropriateness of custody for acutely ill people and efforts are made to divert such people out of the CJS. Persistent petty offenders are often being recycled from the street to police station to court and back to the street without the benefit of care. A dedicated facility is recommended in central London to meet this need.
The purpose of this review is to summarize current understanding of the process of maturation in human brains during the juvenile period to young adulthood. We describe the methods used in such investigations, and outline the main findings regarding the course of brain development. There is much that we do not know about brain maturation, but there is congruence of evidence indicating that brain maturation is not complete until young adulthood (approximately age 21 years). Furthermore, the main index of maturation, which is rate of myelination, points to large variability in the rate of maturation among brain regions. Generally, maturation of association cortex is not complete by late adolescence, and within this cortex the prefrontal regions are last to mature. The review concludes by discussing the behavioral implications of these findings. The role of myelination is to focus and refine the operation of neural networks regulating behavior, and the frontal lobes specifically modulate and inhibit impulses, shaping behavior within the context of the environment in relation to planned action and long-term goals. Because the brain anatomy data indicate that people are not biologically prepared to exercise mature executive control required for full criminal intent until they reach adulthood, juveniles have diminished capacity in this regard and should not be eligible for the most severe punishment available for their crime.
Nursing home residents comprise a large and rapidly growing segment of the national population. Despite this fact, the majority of deaths occurring in nursing homes are not investigated because of the significant medical illnesses suffered by most residents. Herein, we report a series of unnatural deaths in nursing home residents, including two homicides and seven accidental deaths. In four of the deaths, there was an attempted concealment of the cause and manner of death. Fearing criminal or civil proceedings, nursing home personnel may attempt to conceal homicidal or accidental deaths in nursing home residents. Because of the serious, chronic illnesses suffered by these patients, attending physicians are often willing to sign death certificates without personally investigating the circumstances surrounding the patient's demise. The authors contend that unnatural deaths of nursing home patients are significantly underreported. Attending physicians and death investigators should be urged to investigate more fully sudden deaths in nursing home patients.
BACKGROUND: Childhood hyperactivity has previously been found to be closely connected to subsequent alcohol problems and violent offending among men considered to be without major mental disorders. For others, these associations might be moderated or confounded by other factors, predominantly comorbid conduct disorder. AIMS: The purpose of the study was to investigate aspects of childhood hyperactive behaviour in relation to alcohol or violent offences in adult life, taking the possible confounders of early criminality and aggressive behaviour into account. Method A total of 192 young male law breakers and 95 non-criminal controls were followed from age 11-14 years into their thirties. Information on aspects of hyperactivity, aggressive behaviour, early criminality and later offences was included in the analyses. RESULTS: The results supported the hypothesis that aspects of childhood hyperactive behaviour were significantly associated with later drinking offences and violent offending. Further analyses revealed attention difficulties to be the component of hyperactivity most contributing to the relationship. When taking possible confounding variables into consideration, attention difficulties were related to subsequent violent offending among boys with early criminality, independently of early aggressive behaviour. Early criminality, attention difficulties and aggressive behaviour, however, often co-occurred in the same individual. Subsequent drinking offences or violent offending appeared seven times more often among individuals with all early behavioural problems as compared with those who had no such problems. CONCLUSION: Complex antisocial behaviours in adult life commonly represent persistence of complex childhood behavioural difficulties, but among young law breakers there does appear to be a subgroup of boys with a main problem of attention difficulties who go on to violent offending, even in the absence of early manifestation of aggression.
A clinical and psychopathological investigation was carried out in 688 epilepsy patients who had committed in the interparoxysmal period illegal actions. It has been ascertained that criminal actions were committed by the above patients in the presence of the following syndromes: cerebroasthenic emotional lability, psychopathy-like, epileptic, organic, mixed type personality changes, and mental deficiency. Delinquencies were noted to be committed by predominantly mentally deficient patients and by those in the stages of psychopathy-like and epileptic type personality changes.
This article examines sport in childhood and adolescence in relation to mental and social health. On the basis of various investigations, the extent to which sport can have a preventive effect in regard to the development of so-called problem behaviour (criminality, alcohol abuse, drug abuse etc.) is discussed. The article then outlines positive and negative psychosocial effects of sport on the child and adolescent in general, independent of whether problem behaviour develops or not.
In this study, the original Minnesota Multiphasic Personality Inventory (MMPI) was modified slightly by rewording ten items to fit the vernacular of English employed by young men and women in the Republic of Trinidad and Tobago. The response alternatives were extended to include a "don't understand" answer in addition to "true" and "false." To determine the effectiveness of the MMPI for use in this cultural setting, 202 male and 246 female high school students between the ages of 15 and 20 years were examined. Two clinical groups also were studied: 26 male and 32 female adolescents in psychiatric treatment, as well as 49 male and 14 female juvenile offenders incarcerated for various delinquent acts. The retest stability of the basic MMPI scores was evaluated by readministering the MMPI one week later to samples of normal males and females. Validity scale data indicated that these late adolescents were responding to the MMPI in ways comparable to normal and clinical groups in the United States. The results of this investigation support the use of the MMPI in the appraisal of emotional problems of adolescents seen in both the mental health and criminal justice systems in Trinidad and Tobago.
Exhibitionism has historically been viewed as more of a nuisance than a serious criminal justice matter. Research has demonstrated that the number of exhibitionists who are detected re-offending is a significant under-representation of the number who actually re-offend. The objective of this study was to extend a previous study conducted on exhibitionists, while attempting to solve the limitations described in that study. Two hundred eight exhibitionists were assessed at a university teaching hospital between 1983 and 1996. Archival data were derived from police and medical files. Results indicated that, over a mean follow-up period of 13.24 years, 23.6, 31.3, and 38.9 percent of exhibitionists were charged with or convicted of sexual, violent, or criminal offenses, respectively. Undoubtedly, this is an under-representation of the true rate, as we have no way of knowing how many exhibitionists re-offended and did not get caught. Nevertheless, in the present investigation, sexual recidivists compared with non-recidivists were less educated, scored higher on the Michigan Alcohol Screening Test (MAST), the Psychopathy Checklist, Revised (PCL-R), and the Pedophile Index. Violent recidivists were also less educated and scored higher on the MAST, PCL-R, and the Pedophile Index, and had accumulated a greater number of prior violent or criminal charges and/or convictions. Criminal recidivists were less educated; scored higher on the MAST, Buss-Durkee Hostility Inventory (BDHI), PCL-R, and Pedophile Index; and had accumulated a greater number of prior sexual, violent, and criminal offenses. Finally, the hands-on sexual recidivists accumulated a greater number of prior violent and criminal charges and or convictions than did the hands-off sexual recidivists.
This report documents the adjustment to prison life by individuals with schizophrenia and compares their adaptation with a control group with no known mental illness matched for age, race, sex, most serious crime, and security level. On all outcome variables, number of infractions, number of "lock-ups", days in "lock-up," ability to obtain a job in prison, and ability to obtain release from prison, the group with schizophrenia was inferior to the control group. That inmates with schizophrenia may require special assistance in prison and the need for future investigation are discussed.
National and international variations in clinical practice, study methodologies, and data collection make the estimation of patient deaths attributable in some measure to anaesthesia a difficult task. Such rates have undoubtedly significantly declined, a tribute, in large part, to the work of groups such as the International Committee for the Prevention of Anaesthetic Mortality and Morbidity, the Anesthesia Patient Safety Foundation and the Australian Patient Safety Foundation. There is, however, internationally, still a significant risk of mortality associated with anaesthesia which is distinct from that related to any relevant surgery or intercurrent disease. As a matter of pure logic, patients worldwide should be entitled to expect a basic minimum of knowledge and skills from an anaesthetist, as well as his or her use of standard monitoring equipment. In an age where the global provision of health services and equipment may be increasingly dominated, under trade-promoting international agreements, by a few trans-national corporations, and where technology facilitates dissemination of medical data, a unified, worldwide approach to the investigation and prevention of anaesthetic mortality appears both rational and urgent. The benefits of an investigatory system, focused on subsequent safety rather than present liability and standardized through International Conventions, are well established in the air transport industry. We urge the involvement of persons with political and legal expertise in the development of an International Convention for the Investigation and Prevention of Anaesthetic Mortality.
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This article reviews the current programme and legislation relating to drug control and co-operation in drug law enforcement between Canada and other countries. The article also outlines the measures proposed by the authors to promote world-wide co-operation in controlling the illicit traffic in drugs. The authors make the following suggestions: in order to prevent individuals involved in organized crime from profiting from their illegal activities, standards for criminal laws should be established at the international level to ensure that no country or territory can be used as a haven for organized crime and profits derived from it; national Governments must ensure that co-operation is extended to all investigations and enquiries concerning organized crime; bilateral and multilateral treaties should be developed and adopted to ensure the exchange of information and mutual co-operation in law enforcement action against organized crime; international co-operation is needed to ensure the effective prosecution of individuals involved in organized international criminal groups and the removal of their illegally accumulated profits, which should result in the dismantling of the illegal organizations to prevent their entrenchment in contemporary societies.