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性暴力者评估中精神障碍与风险的关联

Linking Mental Disorder and Risk in Sexually Violent Person Assessments.

作者信息

Weinberger Linda E, Sreenivasan Shoba, Azizian Allen, Garrick Thomas

机构信息

Dr. Weinberger is Professor Emerita and Dr. Sreenivasan is Professor of Clinical Psychiatry and the Behavioral Sciences, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA. Dr. Sreenivasan is also with Forensic Outreach Services, and Dr. Garrick is Chief of General Hospital Psychiatry, Greater Los Angeles VA Medical Center, Los Angeles, CA. Dr. Azizian is Assistant Professor of Criminology, California State University, Fresno, and Senior Psychologist, Department of State Hospitals, Sacramento, California. Dr. Garrick, is Professor of Psychiatry, Geffen School of Medicine, University of California, Los Angeles, CA.

出版信息

J Am Acad Psychiatry Law. 2018 Mar;46(1):63-70.

Abstract

A common criticism of sexually violent person (SVP) laws is that psychiatric commitment has been co-opted to continue the incarceration of dangerous criminals, not dangerous individuals with mental illness. This opinion may have credence because some forensic clinicians use a "silo" approach (i.e., diagnosing based on historical criminal behavior rather than current symptomatology, and formulating risk for future sexual violence based on actuarial scores rather than characteristics and features of the mental condition). A silo process fosters a missing link; namely, the absence of a nexus between the mental condition and risk. This approach violates the necessary predicate for involuntary civil commitment, that the symptoms of an individual's current mental disorder be linked to and support a present sexual danger to others. In this article, we provide a brief overview of SVP statutes; describe how the silo approach compromises accurate diagnosis and identification of relevant risk factors; and present actual and fictitious cases illustrating the presence and absence of the missing link.

摘要

对性暴力罪犯(SVP)法律的一个常见批评是,精神病收容已被用于继续关押危险罪犯,而非患有精神疾病的危险个体。这种观点可能有一定道理,因为一些法医临床医生采用“竖井式”方法(即基于历史犯罪行为而非当前症状进行诊断,并基于精算评分而非精神状况的特征来制定未来性暴力风险)。竖井式流程造成了一个缺失环节;也就是说,精神状况与风险之间缺乏联系。这种方法违反了非自愿民事收容的必要前提,即个人当前精神障碍的症状与对他人当前的性危险相关并支持这种危险。在本文中,我们简要概述了SVP法规;描述竖井式方法如何损害准确诊断和相关风险因素的识别;并呈现实际案例和虚构案例来说明缺失环节的存在与否。

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