[Differences in psychiatric expertise of responsibility: Assessment and initial hypotheses through a review of literature].
[Differences in psychiatric expertise of responsibility: Assessment and initial hypotheses through a review of literature].
复制标题
[责任精神病学专业知识的差异：通过文献综述进行评估和初步假设]。
DOI：
10.1016/j.encep.2015.03.002
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
J. Chabannes
中科院分区：
文献类型：
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作者：
J. Guivarch;M. Piercecchi;D. Glezer;J. Chabannes
目的我们的目的是确定精神病学专家之间的主要分歧，并提出解释性的假设。为此，我们在PubMed、Science Direct和Cairn上进行了文献综述，并研究了2007年司法精神病学评估公开听证会的报告，该报告有不同作者的贡献。关键词：司法精神病学、精神病学法庭报告、精神病学鉴定、专家差异、法律责任、辨别力。我们将差异定义为专家之间的分歧，或专家结论和方法的不匹配。结果专家之间的差异主要涉及法医解释，即病理与犯罪之间关系的讨论，特别是在涉及更大的法医讨论的背景下，包括药物中断，药物使用，与反社会人格的关联，预谋，否认事实，特别是当被告患有精神疾病（特别是精神分裂症）时。专家必须考虑两个条件，一个是时间条件（精神疾病必须在犯罪期间活跃），另一个是因果关系，根据专家判例，这涉及寻求犯罪与精神状态之间的直接和排他性关系。有些专家不符合这两种要求或这种法理，由此产生分歧。关于“辨别的改变”的概念也存在诊断上的差异和争议。分歧似乎主要与个人意识形态或不同的思想流派有关，这些思想流派影响了专家的解释和结论，例如问责制作为精神病患者的治疗反应。然后，缺乏明确的专家使命，关于必要的因果关系-任何疾病和犯罪之间-来证明，以取消辨别，也可能导致分歧。此外，完成任务的时间太短，专家不会花足够的时间进行专家审查，这可能导致较差的专门知识和分歧；特别是观察到，临床检查在专业知识方面有时是困难的，误导的，由于被指控的精神疾病的病理沉默，但有时也由于可能的模拟。最后，一些专家报告的质量低下——部分原因是专家缺乏良好的训练，但也有取得专业知识的特殊条件，特别是在监狱里——被一些作者提到是造成差异的原因。从文献综述来看，差异主要涉及司法解释，主要由意识形态来解释。这一综合是在精神病学专家进行研究之前的初步工作。
ObjectivesOur objective was to identify the main points of disagreement between psychiatric experts and to propose explicative hypotheses.Materials and methodsFor this, we carried out a literature review on PubMed, Science Direct and Cairn, and studied the report of the 2007 public hearing on forensic psychiatric assessment with contributions from different authors. The keywords were: forensic psychiatry, psychiatric court report, psychiatric expertise, differences among experts, legal responsibility, and discernment. We defined differences as disagreements between experts, or as a mismatch in conclusions and approaches of experts.ResultsThe differences among experts concerned mainly forensic interpretation, ie the discussion of the relationship between pathology and offense, particularly in contexts that involve a larger forensic discussion, including interruption of medication, use of drugs, association with antisocial personality, premeditation, denial of facts, especially when the accused suffers from a mental illness (especially schizophrenia). For a finding of abolition of discernment, an expert must consider two requirements, one temporal (the mental disease must be active during offense) and the other causal that involves seeking a direct and exclusive relationship between the offence and the mental state, according to expert jurisprudence. Some experts do not comply with these two requirements or this jurisprudence, whence differences. There were also diagnostic differences and disputes relating to the concept of" alteration of discernment". Disagreements appeared to be related primarily to personal ideologies or different schools of thought that influenced interpretations and conclusions of experts, eg accountability as a therapeutic response for the psychotic person. Then, the lack of clarity of expert mission regarding necessary causal relationship—between any disease and crime—to demonstrate to conclude an abolition of discernment, could also contribute to differences. Moreover, time available to achieve the mission is too short and the expert would not devote enough time to an expert examination, which could lead to less good expertise and differences; especially as observed clinical examination in expertise is sometimes difficult, misleading, due to pathological reticence of accused mentally ill but also sometimes due to possible simulations. Finally, the low quality of some expert reports—due in part to the less well-trained experts, but also the particular conditions of achievement of expertise, especially in prisons—were mentioned by some authors as causes of differences.DiscussionIt appears from this review of literature that differences mainly concern forensic interpretation and are mainly explained by ideologies. This synthesis is a preliminary work prior to a study among psychiatric experts.