International Journal of Law and Psychiatry最新文献_第7页

An International Comparison of Psychiatric Advance Directive Policy: Across eleven jurisdictions and alongside advance directive policy 精神病学预先指示政策的国际比较：跨越11个司法管辖区和预先指示政策

IF 1.4 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2025-05-19 DOI: 10.1016/j.ijlp.2025.102098

Sophie Gloeckler , Matthé Scholten , Penelope Weller , Alexander Ruck Keene , Soumitra Pathare , Ramya Pillutla , Leticia Andorno , Nikola Biller-Andorno

The present work provides a comparative policy review of psychiatric advance directives, considering 1) variation across eleven international jurisdictions and 2) differentiation from other advance directive policy. The aim is to support well-founded legal and clinical practice when it comes to psychiatric advance directives by 1) clarifying the range of present approaches and 2) highlighting differential treatment of those with mental health conditions. Applicable statutes in England and Wales; Germany; India; the Netherlands; New South Wales (Australia), Northern Ireland, Virginia (USA); Washington (USA); Switzerland; Scotland; and Victoria (Australia) were reviewed by a team with expertise in law, clinical practice, and ethics. Policy variations were identified related to requirements for validity, activation, amendment, revocation, and override of preferences expressed. Psychiatric advance directives tend to be more strictly regulated and have less legal force than medical advance directives, with more restrictive guidelines and more conditions allowing advance preferences to be overridden. Psychiatric advance directives also tend to be less uniform across jurisdictions, sometimes reflecting varied functions of the directive and sometimes suggesting varied framing of the appropriateness of coercion in psychiatric care. More work is needed to evaluate the validity of distinct psychiatric advance directive policy. Stricter regulation and weaker legal force can serve as barriers to use, and coercion carries associated harms; psychiatric advance directive policy, especially choices that differ from other advance directive policy, should be well-justified.

本工作提供了一个比较政策审查的精神病学预先指示，考虑1)在11个国际司法管辖区的差异和2)从其他预先指示政策的区别。其目的是支持有充分根据的法律和临床实践，当涉及到精神病学预先指示时，1)澄清现有方法的范围，2)强调对精神健康状况患者的不同治疗。英格兰和威尔士的适用法规；德国;印度;荷兰;新南威尔士（澳大利亚）、北爱尔兰、弗吉尼亚（美国）；华盛顿(美国);瑞士;苏格兰;和维多利亚（澳大利亚）由一个具有法律、临床实践和伦理专业知识的小组进行审查。政策变化被确定为与有效性、激活、修改、撤销和覆盖所表达的偏好相关的需求。精神科预先指示往往受到更严格的监管，比医疗预先指示的法律效力更小，有更多的限制性指导方针和更多的条件允许预先偏好被推翻。精神病学预先指示在各个司法管辖区也往往不太统一，有时反映了指示的不同功能，有时暗示了精神病学护理中强迫的适当性的不同框架。需要更多的工作来评估不同的精神病学预先指示政策的有效性。更严格的监管和较弱的法律力量可能成为使用的障碍，而胁迫会带来相关的危害；精神科预先指示政策，特别是与其他预先指示政策不同的选择，应该有充分的理由。

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引用次数: 0

Unified mental health and capacity law: Creating parity and non-discrimination? 统一的精神卫生和行为能力法：创造平等和不歧视？

IF 1.4 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2025-05-19 DOI: 10.1016/j.ijlp.2025.102108

Jill Stavert, Colin McKay

It has been argued that a fusion of mental health and capacity law creates parity and respects non-discrimination. This approach has been adopted in the Mental Capacity Act (Northern Ireland) 2016, although this legislation is not yet fully in force. Separately the World Health Organisation and the Committee on the Rights of Persons with Disabilities have advocated ending the separate status of mental health law. Across the rest of the UK, the possibility of fusion legislation has recently been considered, although not ultimately recommended in 2018 by the Independent Review of the Mental Health Act for England and Wales and in 2022 by the Scottish Mental Health Law Review. Challenges include potential conflicts with Article 5 of the European Convention on Human Rights, and the Committee on the Rights of Persons with Disabilities' critique of ‘mental capacity’ and whether a capacity threshold is required for unified mental health and capacity law. This article will consider the approach of the Scottish Mental Health Law Review, why it did not recommend immediate fusion and its proposals for greater alignment of mental health and capacity regimes.

有人认为，精神健康和行为能力法的融合创造了平等并尊重不歧视。2016年《精神能力法（北爱尔兰）》采用了这种方法，尽管这项立法尚未完全生效。另外，世界卫生组织（World Health organization）和残疾人权利委员会（Committee on Rights of Persons of Disabilities）主张结束精神卫生法的单独地位。在英国其他地区，最近已经考虑了融合立法的可能性，尽管2018年《英格兰和威尔士精神卫生法独立审查》和2022年《苏格兰精神卫生法审查》最终没有提出建议。挑战包括与《欧洲人权公约》第5条的潜在冲突，以及残疾人权利委员会对“精神能力”的批评，以及统一的精神健康和能力法是否需要一个能力门槛。本文将考虑苏格兰精神健康法律评论的方法，为什么它不建议立即融合及其建议更大程度上协调精神健康和能力制度。

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引用次数: 0

Insanity defense for all? The Arab minority in Israel's psychiatric and legal systems

IF 1.4 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2025-05-14 DOI: 10.1016/j.ijlp.2025.102107

Anat Yaron Antar

Objectives

Minorities are often discriminated against by law enforcement. This finding also applies also to the Arab minority in Israel; however, despite extensive research on this topic, only a few studies have examined this bias with regard to psychiatric opinions and judicial decisions on criminal responsibility and the ability to stand trial. This study addresses this bias in its analysis of such opinions and rulings among homicide defendants referred to psychiatric evaluation.

Design

The participants were all the 137 homicide defendants (95 Jews and 42 Arabs) hospitalized in Israeli maximum-security units for psychiatric evaluation or treatment between 1997 and 2021.

Results

A significant relationship was found between the defendant's ethnicity and the evaluation and ruling: half of the defendants deemed fit to stand trial were Jews, while most of those deemed unfit were Jews at a disproportionate rate. In most cases, the court ruling was consistent with the psychiatric opinions, over 98 % of which were provided by Jewish psychiatrists. The low number of Arab psychiatrists prevented examination of the effect of interaction between their ethnicity and the defendants' ethnicity on their opinions.

Conclusion

Three potential explanations for these results are discussed: a true gap between the populations, a lack of cultural competence, and intergroup bias. The implications include the recommendation to train more Arab psychiatrists and enhance the cultural competence of law enforcement officials.

少数民族经常受到执法部门的歧视。这一发现也适用于以色列的阿拉伯少数民族；然而，尽管对这一主题进行了广泛的研究，但只有少数研究调查了精神病学意见和刑事责任和受审能力的司法决定方面的这种偏见。本研究解决了这种偏见，在其分析这些意见和裁决的杀人案被告提到的精神病学评估。参与者是1997年至2021年期间在以色列最高安全单位住院接受精神评估或治疗的所有137名杀人案被告（95名犹太人和42名阿拉伯人）。结果被告人的种族与审判结果有显著的关系：半数被认为适合出庭的被告人是犹太人，而被认为不适合出庭的被告人中犹太人的比例高得不成比例。在大多数情况下，法院的裁决与精神病学的意见是一致的，其中98%以上是由犹太精神科医生提供的。由于阿拉伯精神病医生人数少，因此无法检查他们的种族和被告的种族之间的相互作用对他们意见的影响。结论对这些结果的三种可能的解释进行了讨论：人口之间的真正差距，缺乏文化能力和群体间偏见。其影响包括建议培训更多的阿拉伯精神病医生和提高执法官员的文化能力。

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引用次数: 0

Mental health, medical incapacity, and political leadership in the United Kingdom: A multidisciplinary analysis of the intersections between psychiatry and constitutional law 英国的精神健康、医学上的无行为能力和政治领导：精神病学和宪法法律之间交叉的多学科分析

IF 1.4 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2025-05-14 DOI: 10.1016/j.ijlp.2025.102109

Alexander J. Smith , Stefan Theil , Ashley Weinberg , Dinesh Bhugra , Michael Liebrenz

Mental ill-health and medical incapacity in governmental leadership could affect democratic accountability, possibly necessitating complex psychiatric, judicial, and political interactions. Notably, as a prominent democratic jurisdiction, governmental structures in the United Kingdom and the role of its Prime Minister are generally underpinned by constitutional conventions, rather than enforceable legal frameworks. Political continuity and stability thereby rely on the actions and integrity of constitutional agents, which could engender dilemmas if medical incapacity due to mental ill-health becomes evident. Accordingly, based on a critical analysis of relevant legal documents, this paper examines this largely overlooked topic in relation to the office of the United Kingdom's Prime Minister. In doing so, it does not speculate on the mental health of any individual (past or present) and instead explores hypothetical circumstances and constitutional precedents, including the potential for voluntary resignation and involuntary removal, to promote wider knowledge synthesis. Interdisciplinary interpretations are offered for such situations, where constitutional decisions would likely require informal exchanges with mental health specialists and invoke challenges in conducting psychiatric assessments in politically-charged contexts. Finally, to pre-emptively respond to conceivable scenarios and address existing ambiguities, the paper concludes with some interprofessional recommendations aligned with the democratic values of the United Kingdom.

政府领导中的精神疾病和医疗无能可能影响民主问责制，可能需要复杂的精神病学、司法和政治互动。值得注意的是，作为一个突出的民主司法管辖区，联合王国的政府结构及其首相的作用通常由宪法公约支撑，而不是可执行的法律框架。因此，政治的连续性和稳定性依赖于宪法代理人的行动和正直，如果由于精神疾病导致的医疗能力丧失变得明显，这可能会造成困境。因此，在对相关法律文件进行批判性分析的基础上，本文探讨了与英国首相办公室有关的这个在很大程度上被忽视的话题。在这样做时，它不推测任何个人（过去或现在）的心理健康，而是探索假设的情况和宪法先例，包括自愿辞职和非自愿离职的可能性，以促进更广泛的知识综合。在这种情况下，宪法决定可能需要与心理健康专家进行非正式交流，并对在充满政治色彩的情况下进行精神评估提出挑战，因此提供了跨学科解释。最后，为了先发制人地应对可能出现的情况并解决现有的模糊性，本文最后提出了一些与英国民主价值观相一致的跨专业建议。

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引用次数: 0

Artificial Intelligence (AI) and academic publishing in psychiatry 人工智能（AI）与精神病学学术出版

IF 1.4 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2025-05-03 DOI: 10.1016/j.ijlp.2025.102105

Brendan D. Kelly

The current and potential impact of various applications of artificial intelligence (AI) to the field of academic publishing in psychiatry is the subject of increasing attention. At present, AI algorithms assist in data analysis, allowing researchers to process large datasets quickly and uncover complex patterns that would be challenging to detect manually. In psychiatry, this capability can potentially help integrate data from genetics, neuroimaging, and clinical assessments. AI-driven natural language processing (NLP) tools might also facilitate systematic reviews and meta-analyses by automating the extraction and synthesis of information from vast bodies of published literature. In publishing, AI can potentially help to streamline the publication process in certain ways. Automated systems might screen manuscripts for methodological rigor, ethical compliance, and potential conflicts of interest, thereby reducing the burden on editors by prompting them to consider certain matters, and possibly accelerating the publication timeline. AI-powered tools are already used to help with dissemination of research findings by generating summaries and identifying key insights, making information more accessible to a broader audience. In the future, AI has the potential to enhance psychiatric publishing in various other ways. Predictive analytics might identify emerging trends and research gaps in the literature, guiding future studies and funding priorities, although this remains speculative for now. AI could also facilitate more robust collaborations by connecting researchers with complementary expertise and interests. Additionally, the integration of AI in digital platforms could democratise access to cutting-edge research, promote global knowledge sharing, and accelerate advancements in clinical care. As AI continues to evolve, its applications in research and publishing hold the potential to drive significant progress in understanding and treating mental disorders. It is essential that these developments are accompanied by openness about the use of AI in publishing, with clear declarations by authors and publishers about the use of specific applications in published work.

人工智能（AI）的各种应用对精神病学学术出版领域的当前和潜在影响日益受到关注。目前，人工智能算法有助于数据分析，使研究人员能够快速处理大型数据集，并发现人工检测具有挑战性的复杂模式。在精神病学中，这种能力可能有助于整合来自遗传学、神经影像学和临床评估的数据。人工智能驱动的自然语言处理（NLP）工具也可能通过自动从大量已发表的文献中提取和合成信息，促进系统的回顾和荟萃分析。在出版业，人工智能可以在某些方面帮助简化出版过程。自动化系统可能会筛选手稿的方法严谨性、道德符合性和潜在的利益冲突，从而通过促使编辑考虑某些问题来减轻他们的负担，并可能加快出版时间。人工智能驱动的工具已经被用于帮助传播研究成果，通过生成摘要和识别关键见解，使信息更容易被更广泛的受众获取。在未来，人工智能有可能以各种其他方式加强精神病学出版。预测分析可以识别文献中的新兴趋势和研究差距，指导未来的研究和资助优先事项，尽管这目前仍然是推测性的。人工智能还可以通过将具有互补专业知识和兴趣的研究人员联系起来，促进更强有力的合作。此外，人工智能与数字平台的整合可以使前沿研究的获取民主化，促进全球知识共享，并加速临床护理的进步。随着人工智能的不断发展，其在研究和出版中的应用有可能推动在理解和治疗精神障碍方面取得重大进展。至关重要的是，这些发展伴随着在出版中使用人工智能的开放性，作者和出版商明确声明在出版作品中使用特定应用程序。

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引用次数: 0

Exploring structural stigma towards mental disorders: An analysis of trial verdicts 探索对精神障碍的结构性耻辱：对审判判决的分析

IF 1.4 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2025-04-27 DOI: 10.1016/j.ijlp.2025.102103

Lei Gu , Hongwei Ding

Mental health issues, particularly depression, often carry a stigma that can infiltrate various societal institutions, including the legal system. This study investigates the structural stigma associated with depression within the context of second-instance criminal trials in China, examining trial verdicts from 2009 to 2023. Through a detailed analysis of 171 cases using Semantic Network Analysis, Critical Discourse Analysis, and logistic regression, this research elucidates the complex ways in which depression is considered in judicial decisions. The findings identify three thematic responses—Neutral Evaluation, Sympathetic Consideration, and Rigorous Standards—that encapsulate diverse judicial attitudes towards the impact of depression on criminal responsibility. Critical Discourse Analysis further reveals three prevailing legal discourses—Stringent Criteria, Inconsistent Approaches, and Individual Negligence—that significantly influence the treatment of defendants with depression. The results also show a declining trend in recognizing depression as a mitigating factor, jointly influenced by crime type, defendant gender, and defendant’s education level, suggesting a shift towards more stringent judicial interpretations over time. These findings underscore the critical need for judicial reforms aimed at reducing stigma and promoting a more equitable treatment of mental health issues in the legal system.

精神健康问题，特别是抑郁症，往往带有污名，可以渗透到各种社会机构，包括法律制度。本研究调查了中国二审刑事审判背景下与抑郁症相关的结构性耻辱感，考察了2009年至2023年的审判判决。通过使用语义网络分析、批评话语分析和逻辑回归对171个案例进行详细分析，本研究阐明了在司法判决中考虑抑郁症的复杂方式。调查结果确定了三个主题回应-中立评估，同情考虑和严格标准-概括了对抑郁症对刑事责任影响的不同司法态度。批判性话语分析进一步揭示了三种流行的法律话语-严格的标准，不一致的方法和个人疏忽-显着影响抑郁症被告的治疗。结果还显示，在犯罪类型、被告性别和被告教育水平的共同影响下，将抑郁视为减轻因素的趋势有所下降，这表明随着时间的推移，司法解释将朝着更严格的方向转变。这些调查结果强调，迫切需要进行司法改革，以减少耻辱，并促进在法律制度中更公平地对待精神卫生问题。

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引用次数: 0

Insanity defense and social dangerousness: A comparative study between China and Italy 精神错乱辩护与社会危险性：中国与意大利的比较研究

IF 1.4 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2025-04-26 DOI: 10.1016/j.ijlp.2025.102100

Huan Wan , Giovanna Parmigiani , Stefano Ferracuti , Ping Yan

The determination of criminal responsibility and the evaluation of social dangerousness in the criminal proceedings of offenders with mental disorders are crucial and complex issues. Forensic psychiatric evaluation practices and regulations vary significantly across jurisdictions, offering comparative analysis opportunities. This paper compares the forensic psychiatric evaluation processes in China and Italy, emphatically examining and analyzing the assessment of criminal responsibility and social dangerousness. The shared language, the potential for harmonizing forensic psychiatry practices, and the pursuit of unified and transparent standards and practices underscore the importance of conducting cross-national comparative research.

精神障碍罪犯刑事诉讼中的刑事责任认定和社会危险性评价是一个重要而复杂的问题。不同司法管辖区的法医精神病学评估实践和法规差异很大，提供了比较分析的机会。本文比较了中国和意大利的司法精神病学鉴定过程，重点考察和分析了刑事责任和社会危险性的鉴定。共同的语言，协调法医精神病学实践的潜力，以及追求统一和透明的标准和实践，都强调了开展跨国比较研究的重要性。

引用次数: 0

Mental health disorders, adverse childhood experiences and accelerated reoffending among justice-involved youth in Australia: A longitudinal recurrent event analysis 精神健康障碍、不良童年经历和加速再犯罪在澳大利亚司法参与青年：纵向复发事件分析

IF 1.4 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2025-04-25 DOI: 10.1016/j.ijlp.2025.102099

Emaediong I. Akpanekpo , Tony Butler , Preeyaporn Srasuebkul , Julian N. Trollor , John Kasinathan , David Greenberg , Peter W. Schofield , Dianna T. Kenny , Claire Gaskin , Melanie Simpson , Jocelyn Jones , Anyiekere M. Ekanem , Azar Kariminia

Background

Mental health disorders and adverse childhood experiences (ACEs) are known risk factors for youth offending. However, most studies operationalize these factors as static and fail to distinguish between isolated reoffences and escalating patterns of criminal behaviour. The impact of mental health service engagement on interrupting cyclical, repetitive offending also remains unclear.

Methods

We linked offending records (1994–2022) and mental health records (2001−2022) for 1556 justice-involved youth in New South Wales, Australia. The Prentice, Williams, and Peterson Gap Time model with time-varying effects was used to identify factors associated with accelerated reoffending during a five-year follow-up.

Results

The median age at first conviction was 15 years for custody-supervised youth and 16 years for community-supervised youth. Among custody-supervised youth aged 14 to 17, the prevalence of ACEs, mental health disorders, and their co-occurrence were 69.6 %, 33.9 %, and 26.5 %, respectively, compared to 42.5 %, 30.8 %, and 14.8 % for community-supervised youth. Recurrent offences occurred in 64.8 % of custody-supervised youth and 52.1 % of community-supervised youth. Age, physical neglect, substance use disorders, and personality disorders demonstrated time-varying effects on reoffending risk. Additional risk factors included physical abuse, parental death, anxiety disorders, mood disorders, and previous incarceration. Mental health service contact was associated with reduced reoffending risk.

Conclusions

This study demonstrates the dynamic nature of criminogenic risk factors and the protective effect of mental health service engagement. Youth justice policymakers should prioritize regular mental health assessments and improved access to interventions for justice-involved youth to reduce recurrent offending and enhance public safety.

心理健康障碍和不良童年经历（ace）是青少年犯罪的已知危险因素。然而，大多数研究将这些因素视为静态的，未能区分孤立的再犯罪和犯罪行为升级模式。参与心理健康服务对中断周期性、重复性犯罪的影响也尚不清楚。方法：我们将澳大利亚新南威尔士州1556名参与司法的青少年的犯罪记录（1994-2022年）和心理健康记录（2001 - 2022年）联系起来。采用具有时变效应的普伦蒂斯、威廉姆斯和彼得森间隔时间模型，在5年随访期间确定与加速再犯有关的因素。结果初犯年龄中位数在监管青少年中为15岁，在社区监管青少年中为16岁。在14至17岁的监护青少年中，ace、精神健康障碍及其共患率分别为69.6%、33.9%和26.5%，而社区监护青少年的这一比例分别为42.5%、30.8%和14.8%。受羁留青少年中有64.8%及社区监督青少年中有52.1%犯过重复罪行。年龄、身体忽视、物质使用障碍和人格障碍对再犯风险表现出时变效应。其他风险因素包括身体虐待、父母死亡、焦虑症、情绪障碍和以前的监禁。心理健康服务接触与再犯风险降低有关。结论本研究揭示了犯罪风险因素的动态性质和心理健康服务参与的保护作用。青年司法政策制定者应优先考虑定期进行心理健康评估，并改善参与司法的青年获得干预的机会，以减少复发性犯罪并加强公共安全。

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引用次数: 0

Cognitive biases in forensic psychiatry: A scoping review 司法精神病学中的认知偏差：范围综述

IF 1.4 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2025-03-05 DOI: 10.1016/j.ijlp.2025.102083

L. Buongiorno , F. Mele , G. Petroni , A. Margari , F. Carabellese , R. Catanesi , G. Mandarelli

Forensic psychiatry plays a critical role in legal contexts but is highly susceptible to cognitive biases that can undermine the accuracy and objectivity of evaluations. This scoping review, guided by the Arksey and O'Malley framework, aims to identify and analyze cognitive biases within forensic psychiatric practice across criminal, civil, and testimonial domains.

A comprehensive search across five databases yielded 7002 records, with 24 studies meeting the inclusion criteria. From these studies, ten distinct cognitive biases were identified, with the most frequently discussed being gender bias (29.2 %), allegiance bias (20.8 %), and confirmation bias (20.8 %), followed by hindsight, cultural, and emotional biases. Most studies focused on criminal settings, with only two addressing civil contexts.

Among the mitigation strategies reviewed, structured methodologies and the “considering the opposite” technique were the most positively evaluated and widely discussed approaches. Conversely, the self-awareness strategy was criticized for its limited effectiveness in reducing bias. Emerging tools, such as artificial intelligence, offer potential solutions but require robust ethical safeguards to prevent the perpetuation of systemic biases.

This scoping review provides a comprehensive overview of the current state of research on biases in forensic psychiatry, underscoring the need for further empirical studies to explore their prevalence, mechanisms, and effective mitigation strategies in greater depth.

法医精神病学在法律环境中发挥着关键作用，但极易受到认知偏见的影响，从而破坏评估的准确性和客观性。在Arksey和O'Malley框架的指导下，这一范围审查旨在识别和分析刑事、民事和证词领域法医精神病学实践中的认知偏见。在5个数据库中进行全面搜索，得到7002条记录，其中24项研究符合纳入标准。从这些研究中，确定了十种不同的认知偏见，其中最常被讨论的是性别偏见（29.2%）、忠诚偏见（20.8%）和确认偏见（20.8%），其次是后见之明、文化和情感偏见。大多数研究集中在刑事背景下，只有两项研究涉及民事背景。在审查的缓解战略中，结构化方法和“相反考虑”技术得到了最积极的评价和广泛讨论。相反，自我意识策略因其在减少偏见方面的有效性有限而受到批评。人工智能等新兴工具提供了潜在的解决方案，但需要强有力的道德保障，以防止系统性偏见的延续。本综述全面概述了法医精神病学中偏见的研究现状，强调需要进一步的实证研究，以更深入地探讨其流行、机制和有效的缓解策略。

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引用次数: 0

ADHD in adults and criminal behavior: The role of psychiatric comorbidities and clinical and sociodemographic factors in a clinical sample 成人ADHD与犯罪行为：精神合并症、临床和社会人口因素在临床样本中的作用

IF 1.4 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2025-03-05 DOI: 10.1016/j.ijlp.2025.102088

Martina Nicole Modesti , Silvia Gubbini , Pietro De Rossi , Agostino Manzi , Giuseppe Nicolò , Barbara Adriani , Simone Pallottino , Giovanna Parmigiani , Antonio Del Casale , Cecilia Guariglia , Stefano Ferracuti

Introduction

ADHD is a neurodevelopmental disorder associated with functional, behavioral, and relational difficulties. Its onset is in childhood, before the age of 12, and it often persists into adulthood. This study investigates the link between ADHD in adulthood, psychiatric comorbidities, and the risk of criminal behavior, analyzing the impact of clinical and sociodemographic variables.

Methods

This cross-sectional study included a sample of 308 patients diagnosed with ADHD, treated at the ADHD Outpatient Clinic of SS Gonfalone Hospital in Monterotondo between 2019 and 2024. Diagnoses and comorbidities were assessed through structured interviews and standardized diagnostic tools (ASRS, DIVA-5). Information on legal status and types of crimes was collected through individual interviews. Statistical analysis was performed using t-tests, chi-square tests, and stepwise logistic regression models.

Results

In the sample, 8.1 % of patients with ADHD had committed crimes, with a male prevalence (92 %). Significant predictors of criminal behavior included male gender (OR = 1.899, p = 0.004) and alcohol use disorder (OR = 4.59, p = 0.002). Additionally, oppositional defiant disorder, ADHD diagnosis before the age of 18, and unemployment showed a potential association with risky criminal behavior. Lifetime prescription of antipsychotics (61.4 %) and antiepileptics (48.7 %) was more frequent among participants who committed crimes, while no significant differences were found in the use of atomoxetine and methylphenidate.

Conclusions

Adult ADHD, particularly in males, with combined presentation and in the presence of comorbidities such as oppositional defiant disorder and alcohol use disorder, is associated with an increased risk of criminal behavior. The findings highlight the need for personalized and multimodal interventions to mitigate these risks. Future studies should adopt longitudinal designs to explore causal dynamics and evaluate the effectiveness of therapeutic strategies in forensic contexts.

adhd是一种与功能、行为和关系困难相关的神经发育障碍。它的发病是在儿童时期，在12岁之前，并且经常持续到成年。本研究调查了成年期ADHD、精神合并症和犯罪行为风险之间的联系，分析了临床和社会人口学变量的影响。方法：本横断面研究包括2019年至2024年间在蒙特罗通多SS Gonfalone医院ADHD门诊接受治疗的308例ADHD患者样本。通过结构化访谈和标准化诊断工具（ASRS, DIVA-5）评估诊断和合并症。通过个别面谈收集了有关法律地位和罪行类型的资料。采用t检验、卡方检验和逐步logistic回归模型进行统计分析。结果8.1%的ADHD患者有过犯罪行为，其中男性占92%。犯罪行为的显著预测因子包括男性性别（OR = 1.899, p = 0.004）和酒精使用障碍（OR = 4.59, p = 0.002）。此外，18岁前的对立违抗性障碍、ADHD诊断和失业显示出与危险犯罪行为的潜在关联。终身服用抗精神病药物（61.4%）和抗癫痫药物（48.7%）的比例在犯罪参与者中更为常见，而使用阿托莫西汀和哌醋甲酯的比例无显著差异。结论：成人ADHD，特别是男性，合并表现并伴有对立违抗性障碍和酒精使用障碍等合并症，与犯罪行为风险增加有关。研究结果强调需要个性化和多模式干预措施来减轻这些风险。未来的研究应该采用纵向设计来探索因果动态和评估在法医环境下治疗策略的有效性。

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引用次数: 0