Chu Elvina May-Yin, O'Neill Mari, Purkayastha Debasish Das, Knight Caroline
1Huntington's Disease Centre, UCL Institute of Neurology, 2nd Floor Russell Square House, London, WC1B 5EH UK.
2Department of Psychiatry, Queen's University, Kingston, ON Canada.
J Clin Mov Disord. 2019 Jul 24;6:3. doi: 10.1186/s40734-019-0078-x. eCollection 2019.
Huntington's disease (HD) is an autosomal dominant, neurodegenerative disorder. Associated cognitive deficits including impulsivity and disinhibition are the same factors that also predispose to forensic risk. Men tend to be perpetrators of more severe violent behaviours than women and women are less likely than men to be arrested for violence. This finding is not applicable in the case of women with Huntington's disease and explored in the three clinical cases of women with HD and their forensic histories that are subsequently described.
'A' was admitted from court following a charge of arson and reckless behavior, with increasing severity and frequency of self-harm and attempted suicide. This case demonstrates someone who had previously presented to psychiatric services on multiple occasions for various reasons, culminating in a serious criminal charge of arson due to psychiatric symptoms associated with HD.'B' was arrested and imprisoned after having been charged with actual bodily harm (ABH) for assaulting her partner and young daughter then breaking her bail conditions. Although she was gene positive for HD she had no neurological symptoms of the disease. was given leave but needed to be recalled to hospital by police. Six weeks later the medical recommendation for a court imposed hospital order was overturned as presented and articulated her case so convincingly in court. This case demonstrates that even in the absence of psychiatric history or movement disorder there may be substantial forensic risk indicated by subtle underlying cognitive deficits due to changes in executive function affecting the frontal lobes.'C' was admitted to acute psychiatric services after being found wandering in traffic wanting to die. She had been diagnosed with HD in the previous year and had a long criminal record on a background of alcohol dependency. Following transfer to a specialist psychiatric unit, she engaged well with a neurobehavioural levels system which rewards desirable and appropriate behaviours and she responded well to a highly structured environment resulting in discharge to a community placement.
These three case studies aim to highlight the need to raise awareness of the increased forensic risk in women with HD. Although criminal behaviour is less frequently observed in women than men and usually violence is less severe in women, HD may cause or contribute to criminal behaviour that can be violent in nature in women who are gene carriers for HD even in the absence of movement disorder, psychiatric symptoms or overt cognitive deficits. Assessment and earlier treatment in appropriate hospital settings may successfully contain and modify behaviours leading to reduced levels of risk and recidivism in this vulnerable patient group.
亨廷顿舞蹈症（HD）是一种常染色体显性神经退行性疾病。相关的认知缺陷，包括冲动和去抑制，也是导致法医风险的因素。男性往往比女性实施更严重的暴力行为，而女性因暴力行为被捕的可能性低于男性。这一发现不适用于患有亨廷顿舞蹈症的女性，本文通过随后描述的三例患有HD的女性及其法医病史对此进行探讨。
“A”因纵火和鲁莽行为的指控从法庭被送来就医，其自残和自杀未遂的情况愈发严重且频繁。该病例表明，此人此前曾因各种原因多次前往精神科就诊，最终因与HD相关的精神症状而面临严重的纵火刑事指控。“B”因袭击伴侣和年幼女儿并违反保释条件而被指控实际身体伤害（ABH），随后被捕并入狱。尽管她HD基因检测呈阳性，但没有该疾病的神经症状。她被准予保释，但警方需要将她召回医院。六周后，由于她在法庭上如此令人信服地陈述了自己的情况，法院下达的医院强制令的医学建议被推翻。该病例表明，即使没有精神病史或运动障碍，由于影响额叶的执行功能变化导致的细微潜在认知缺陷，也可能表明存在重大的法医风险。“C”被发现徘徊在车流中试图自杀后，被送往急性精神科。她去年被诊断出患有HD，并有长期酗酒导致的犯罪记录。转至专科精神科病房后，她积极配合神经行为分级系统，该系统奖励期望和适当的行为，她对高度结构化的环境反应良好，最终出院并被安置到社区。
这三个案例研究旨在强调提高对HD女性法医风险增加的认识的必要性。尽管女性犯罪行为比男性少，且女性暴力行为通常不那么严重，但HD可能导致或促成基因携带HD的女性出现暴力性质的犯罪行为，即使没有运动障碍、精神症状或明显认知缺陷。在适当的医院环境中进行评估和早期治疗，可能成功控制并改变行为，从而降低这一脆弱患者群体的风险水平和再犯率。
