Methods
The most important part of forensic psychiatric examination in the
Brazilian legal system is assessment of the offender’s criminal
responsibility. According to the Brazilian Penal Code, the evaluation of
criminal responsibility is based on a biopsychological definition. Full
penal responsibility can only be ruled out if the offender was suffering
from a mental disorder (biological component) at the time of the
criminal act and was thus completely incapable of understanding the
unlawful nature of his or her act or to refrain from committing it
(psychological component). The existence of a causal link between the
mental disorder and the offense must be established beyond a reasonable
doubt. Studies have also acknowledged the possibility of cases with
limited criminal responsibility, resulting from partial impairment of
cognitive or volitional functions. Individuals classified as not
responsible for their offense are committed to involuntary treatment in
forensic psychiatric hospitals. In cases of limited responsibility, the
courts can also order the individual’s compulsory treatment.
All female offenders with mental disorders and ruled not guilty by
reason of insanity (NGRI) by the criminal courts in the state of Rio de
Janeiro, Brazil, were committed to a forensic psychiatric facility. Our
initial study sample consisted of 29 female offenders in treatment at
the facility, 14 of whom had committed homicide or attempted homicide.
All 29 study participants had been previously assessed by forensic
psychiatrists as part of pretrial procedures. The study’s principal
author (AMV) also examined these patients in the summer and autumn of
2007. Identification data provided here refer to the time of the
offense. Legal and medical files were also screened for relevant
information (e.g. criminal records, descriptions of the crime’s
circumstances).
A conclusive psychiatric diagnosis was established on the basis of a
psychiatric examination conducted by an experienced clinician (AMV)
using the Structured Clinical Interview for DSM-IV
mental14 and personality disorders15and clinical and forensic records. We applied the positive and negative
syndrome scale (PANS)16 in the
schizophrenia/schizoaffective disorder group. Patients were also asked
to complete a questionnaire specifically created to collect
sociodemographic and clinical data. The study was approved by the local
Institutional Review Board, and all patients signed a voluntary consent
form.
We selected all the patients whose offenses were related to some type of
violent behavior. Patients that had committed non-violent offenses such
as petty theft were not included in the study. Aggressive behavior was
defined as: homicide or attempted homicide, aggravated physical assault
or assault with a deadly weapon, armed robbery, kidnapping, illegal
possession of firearms involving threat, destruction of property with
violent behavior during the act, and sexual crimes. Of the 29 patients
institutionalized at the time, 28 had committed at least one of these
felonies. There were no cases of sexual crimes.
The study was approved by the Institutional Review Board of the
Institute of Psychiatry, Federal University of Rio de Janeiro, and the
office of the director of the forensic psychiatric hospital where the
interviews with patients were performed. All patients signed a consent
form about their participation in the study