Various forms of reactive syndromes are discussed by the authors in a historical perspective. In the second part of the paper various types of reactive disorders are described, including prison psychoses. Current classifications, DSM-IV and ICD-10, have been also taken into account. In conclusions it is stated that typical reactive psychoses occur rather seldom nowadays, while depressive and anxiety syndromes, as well as hallucinatory-delusional syndromes are diagnosed more often. Reactive symptoms are noted presently in proceedings concerned with disability pensioning and indemnification more often than formerly.
The paper is devoted to major legal issues pertaining to the formulation of psychiatric and psychological expert opinions for the needs of court penal proceedings. The following questions are discussed: conditions of admissibility of evidence from expert opinions in penal proceedings, conditions of admissibility of evidence from psychiatric-psychological opinion, and some more detailed issues, regarding the subject of a psychiatric opinion, qualifications of the expert psychiatrist, methods of examination, psychiatric observation, the opinion form and content, transactions of the court in proving evidence of this sort. In conclusions it is pointed out that for effective proving evidence from psychiatric-psychological opinion, a close co-operation and mutual understanding are necessary between court experts on the one hand, and judges and prosecutors on the other hand. Acquirement of working knowledge of the penal law and procedure by court experts, as well as of rudiments of psychiatry by lawyers is considered to be one of the most important conditions.
Due to limited possibilities of rapid and regular transference of medical science advances onto the field of forensic psychiatry, ethical, legal, and social problems arise. Some of the latter, especially these connected with knowledge and moral attitudes of court experts, are discussed.
Some medical and legal aspects of risks connected with sudden onset of reactive disorder s in disaster victims are outlined in the paper. Particular emphasis is laid upon factors impeding the formulation of forensic psychiatric expert opinions in disaster medicine.
The paper presents possibilities of application of contemporary psychological knowledge, especially of the stress concept, in the diagnostics of reactive disorder s in psychiatric and psychological forensic expert opinions. Particular attention is paid to the effect of political transformations upon the pattern and onset of reactive disorder s, and to related problems in expert opinions formulation.
The paper presents a new psychological test – SUI (Interpersonal Relations Scale, IRS), developed by the author. The scale allows to make a psychological diagnosis in terms of interpersonal functioning of personality. Assumptions underlying the test construction, normalization data, and principles of individual scores interpretation in the diagnostic practice are described. Moreover, the author's research results regarding three neuroses: hysteria, neurasthenia and depression are reported. The findings indicate a considerable usefulness of the test in psychological differential diagnosis of these neurotic disorders.
Contemporary opinions and approaches concerning reactive disorders are overviewed in the paper, with the focus on legal aspects. These problems are discussed both in their theoretical dimension, i.e. in terms of current modifications in the classification and definitions of reactive disorders, and in the practical aspect, regarding a lack of correspondence between the penal and civil code regulations and advances in modern psychiatry. Difficulties are analyzed ensuing in the court practice from the application of new concepts related to the picture of post-traumatic stress disorder in its acute and chronic form. It is emphasized that detailed, measurable diagnostic criteria should be used, which would allow to diagnose more often the acute (ASD) and chronic (PTSD) stress disorder in forensic psychiatric practice.
Due to the complexity of defence attitudes, behaviors and reactions displayed by the disabled, the expert psychologist must analyze most carefully not only motives underlying prohibited acts committed by such persons, but also their defence reactions occurring after the act – in prison or during hospital observation. Moreover, the effect of defence reactions on disabled persons' ability to participate in court proceedings, as well as their accountability have to be taken into account.
The Convention on Human Rights and Basic Freedoms constitutes an exemplary of effective protection of human rights in Europe. 236 opinions issued by the European Tribunal of Human Rights have been analyzed by the authors, who have drawn from their analysis conclusions relevant to medical practice.
Subjects in the study were 30 male HIV-infected prisoners serving long-term sentences. The cause of reactive depression in this sample was found to be not the long-term isolation, but a sudden deterioration of somatic health resulting from AIDS.
The author describes examples of undesirable behaviors of psychiatrist's in general psychiatric practice, affecting the image of the profession as perceived by the administration of justice and local community representatives. The following categories of such behaviors were distinguished: (l) submitting to pressures of persons against whom penal proceedings are conducted, (2) issuing certificates that either are beyond the competences of the psychiatrist not being a court expert, or have no confirmation in medical records, (3) inappropriate documentation of the patient's medical history, and (4) willful undertaking the forensic expert's actions without authorization by the court by which penal proceedings are instituted.
The authors present research results obtained from 20 female homicides serving the penalty of imprisonment. The average woman was 36 years old, with a blue-collar background, had an elementary education or basic vocational training, was a blue-collar worker, and lived in a large city. In the majority of cases (75%) personality disorders, neurosis or organic disorders were diagnosed. A half of the subjects suffered from chronic somatic conditions. In the course of imprisonment in a vast majority of cases reactive disorder s were found, predominantly episodic conditions in the form of adaptation disorders, and as regards reactive psychoses – depressive syndromes prevailed.
Some psychological theories (of labeling, Adler's theory of individual psychology and compensation), as well as difficult situations encountered by the disabled are outlined by the author. On the grounds of the presented theories and situations an attempt is made to explain defence behaviors and reactive disorders occurring in such persons in stressful circumstances, including imprisonment.
Clinical patterns of reactive disorders are presented in selected groups of persons who committed prohibited acts in the years 1991-1995. The existing tendencies are analyzed and attention is drawn to some new determinants of reactive disorders onset, as well as to errors in diagnosing such disorders.
In the context of the distinguished in the penal code criminological, psychological and psychopathological determinants of the transgression of self-defence limits, as well as of legal and penal consequences of such an event, the authors point out to cases of disregarding by the administration of justice any individually differentiated situational decompensations and personality reactions or complicating reactive disorders. Moreover, not only mental status and psychomotor reactivity of the self-defending victim of lawless attempt are emphasized, but also health-related and important for the proceedings consequences of the so-called post-traumatic stress disorder (PTSD) resulting from the attempt.
Receiving stolen property under aggravating circumstances is discussed in terms of both its interpretation accepted in the penal code and the authors' observations from their many years' forensic psychiatric practice. Shortcomings of the interpretation and its elements incompatible with the present political and economic situation of the State are pointed out, as well as prosocial personality traits in many perpetrators of this offence. Besides, it is emphasized that many individuals are accidentally involved in prohibited acts of this sort. Thus, the socio-legal justifiability of the definition of receiving stolen property under aggravating circumstances is put to doubt, since offence of this type is not counterbalanced by any alternative privileged type.
The problems of reactive disorders, their diagnostics and assessment are discussed in the light of Lithuanian forensic psychiatry experiences. The problems are exemplified by cases of reactive disorders in mildly mentally handicapped persons.
Difficulties in the treatment and rehabilitation of reactive disorders are discussed on the example of two selected forensic psychiatric opinions. A tendency to prolong proceedings in investigation cases and to carry out forensic psychiatric expertises mostly in the stage of preparatory proceedings is pointed out.
The paper presents a review of the literature on the role of supplementary investigations of the brain in forensic psychiatric opinions. The majority of publications represent the standpoint that in the appraisal of accountability such data have an auxiliary role and should be interpreted in a close connection with the perpetrator's clinical status. It is not always the case in the practice of pronouncing expert opinions, which is exemplified by two forensic psychiatric opinions enclosed.
The regulations are presented concerning the appointment of expert psychiatrists in cases of nullification of marriage before Bishops' Court, as well as psychiatrists' ethical-deontological problems connected with serving such a function.
The origins, specificity and difficulties in the development of the ethical code of expert psychiatrist are discussed. The author specified criteria that should be met by such a code, and potential beneficial consequences of its application by psychiatrists.
Regulations and practices that have been in force for over two decades now in the USA regarding decision making in cases of involuntary commitment of persons manifesting mental disorders are presented in the paper.