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