Analysis Of The Past Diagnosis And Treatment In 1369 Cases Of Forensic Psychiatric Expertise

Background:People with mental disorders are a special social group and are a high-risk group with criminal behavior.Criminal suspects suspected to have a mental disorder are required to carry out judicial psychiatric identification,to provide the expert testimony and trial medical evidence for the judicial department.The previous clinical diagnosis and treatment data provided by the appraisee is an important reference to conduct the identification diagnosis.However,currently there is a lack of systematic investigation and analysis to the past clinical diagnosis and treatment data of the appraisees.Objective:To explore the differences of the past diagnosis and treatment in patients with the identification diagnosis of mental disorders and no-mental disorders as well as the consistency between the identification diagnosis and the pre-identification clinical diagnosis in identification and diagnosis,it conducted a analysis of the demographic data,criminological characteristics,appraisal opinions and past clinical diagnosis and treatment data in the cases of forensic psychiatrics expertise,to provide reference for the judicial psychiatric evaluation opinions.Methods:Retrospective case analysis and research were used,with a application of self-compiled questionnaire(contents include general demographic characteristics,cause of identification,identification and diagnosis,determination of criminal responsibility ability,past history of mental disorders,pre-and post-incident diagnosis and treatment,etc.).The general case information and diagnosis and treatment information before identification in 1369 criminal suspects undergoing criminal responsibility ability assessment from 2014 to 2017 in the research institute were collected,and the patients were divided into two groups according to the identification and diagnosis:the mental disorder group and the non-mental disorder group,with inter-group comparison and intra-group analysis.All data were statistically analyzed on the SPSS20.0software.Results:1.There were statistically significant differences in the age,occupation,and culture level between the mental disorder group and the non-mental disorder group(P>0.05).In terms of the type of case involved,The proportion of personal attack cases in the mental disorder group was higher than that in the non-mental disorder group(67.2%vs 53.8%,?~2=22.008,P<0.001),especially in the case of homicide.In the case of the mental disorder group,the proportion of the cases of economic invasion was higher than the non-mental disorder group(24.4%vs15.6%,?~2=15.127,P<0.001).2.The proportion of patients with the history of mental abnormality and the rate of clinical visits in the mental disorder group were higher than those in the non-mental disorder group(97.1%vs 76.0%,?~2=152.246,P<0.001;65.2%vs 44.0%,?~2=53.459,P<0.001).The duration time or course of mental abnormality in the mental disorder group was significantly longer than those in the non-mental disorder group(10.37 years vs 4.34 years,z=-8.432,P<0.001).3.The medical visit rate after the crime in non-mental disorder group was higher than that in the mental disorder group(33.7%vs12.1%,?~2=46.302,P<0.001).The number of medical visits in the non-mental disorder group was less than that in the mental disorder group(z=37 714,P<0.05).4.Among the various diseases in the mental disorder group,the patients with hysteria/stress/neurosis had the highest proportion of clinical diagnosis(86.7%),while the patients with mental retardation had the lowest proportion of clinical diagnosis(9.6%).5.The overall consistency rate of diagnosis and clinical diagnosis was from high to low is as follows:Schizophrenia(98.4%),mood disorder(79.6%),organic mental disorder(70.4%),hysteria/stress/neurosis(65.4%),mental retardation(66.7%),psychoactive substance-induced mental disorder(64.4%),personality and behavior disorder(33.3%).The overall consistency rate of clinical diagnosis was84.1%,and the Kappa value was 0.759.6.In cases where the identification diagnosis is inconsistent with the clinical diagnosis,the most common clinical diagnoses in both groups were schizophrenia,mood disorder and hysteria/stress/neurosis.Conclusion:1.Compared with those with mental disorders,those without mental disorders in forensic psychiatric expertise are younger,more stability in occupation,more educated,and more inclined to economic aggression cases,the proportion of those with previous history of mental abnormalities is lower,the time/course of mental abnormalities is shorter,the rate of clinical visits is lower,the proportion of visits after the crime is higher,and the number of visits is lower.2.In the forensic psychiatry identification which can provide the data of clinical diagnosis and treatment,the identified person who is diagnosed as having mental disorder has a high consistency between clinical diagnosis and identification diagnosis,the stability of disease diagnosis is basically good.The clinical diagnosis has a good reference value for the forensic psychiatry identification.3.The most patients with schizophrenia in criminal suspects,patients with mental retardation,the lowest rate of clinical visits,these two types of patients and their families should be the focus of prevention and control of mental disorders in the cause of trouble.4.The most patients with schizophrenia in criminal suspects,patients with mental retardation,the lowest rate of clinical visits,these two types of patients and their families should be the focus of prevention and control of mental disorders in the cause of trouble.