Factitious Disorder Imposed on Another (FDIA), formerly known as Munchausen Syndrome by Proxy, is a rare form of abuse where parents induce or fabricate symptoms in their child, exposing them to unnecessary and potentially harmful medical treatments. In over 90

This study investigates the decision-making capacities of patients with bipolar disorder (BD) and schizophrenia spectrum disorders (SSD), focusing on differences across four dimensions assessed by the MacArthur Competence Assessment Tool for Treatment (MacCAT-T): Understanding, Appreciation, Reasoning, and Expressing a Choice. A total of 398 patients (237 SSD and 161 BD) were included, with data collected from both inpatient and outpatient settings. Patients with SSD exhibited greater psychopathological severity, were predominantly male, and had a lower level of education compared to BD patients. No significant differences were found between groups in Understanding, Reasoning, or Choice dimensions of the MacCAT-T. However, BD patients scored higher in the Appreciation domain, indicating a better ability to recognize the relevance of medical information to their personal circumstances. Psychopathological severity, measured by the Brief Psychiatric Rating Scale (BPRS) and Positive and Negative Syndrome Scale (PANSS), significantly influenced MacCAT-T scores. In SSD patients, conceptual disorganization and lack of judgment negatively impacted decision-making, while BD patients were adversely affected by somatic concerns and hostility. Cognitive impairments, particularly in SSD, appeared to contribute to differences in the Appreciation domain. The study highlights the influence of psychopathology on decisional capacity in severe mental illness, with implications for tailored clinical interventions. Despite similar overall capacity levels between groups, further research is needed to explore the role of cognitive and contextual factors in shaping these abilities. These findings support the use of standardized tools to guide clinical assessments and ensure informed decision-making in psychiatric care.

Objectives Adverse event (AE) reporting is crucial to ensure patient safety and prevent future incidents, yet AEs are often underreported. Exploring healthcare professionals’ attitudes toward AE reporting is essential for addressing this gap. This study aimed to translate and validate the Italian version of the reporting of clinical adverse events scale (RoCAES), originally developed in 2008, and assess its reliability and applicability in the Italian healthcare system. Methods We developed the Italian RoCAES (I-RoCAES) through translation and back-translation. Healthcare professionals were given an electronic scale version created using Google Forms for anonymous data collection between October 2021 and October 2023. Confirmatory factor analysis (CFA) was conducted to evaluate the original scale's factor structure, followed by exploratory factor analysis (EFA) to refine the model. Internal consistency (Cronbach's alpha and Guttmann coefficient) and CFA results for the I-RoCAES were also analyzed. Results The study sample consisted of 778 healthcare professionals, including physicians, nurses, and nursing students, aged 44.2 years (SD = 15.4) on average. In total, 51.9% had been involved in AEs, but only 33.7% reported it. The data we retrieved from Italian healthcare professionals did not fit well during CFA, which led to an EFA identifying a four-factor solution that accounts for 43.9% of the variance. The I-RoCAES showed good internal consistency (Cronbach's alpha = 0.79; Guttmann coefficient = 0.77) and improved CFA fit indices. Conclusions Due to its good psychometric properties, the I-RoCAES can be utilized to study and promote AE reporting among Italian healthcare professionals.

Background: Italy’s forensic psychiatric system has undergone major reforms over recent decades, shifting from custodial institutions to a right-based, community-oriented model. While internationally praised for its commitment to dignity, recovery, and social reintegration, this framework presupposes a degree of clinical recoverability that is not always achievable. Individuals with chronic, treatment-resistant disorders—particularly those who remain socially dangerous—pose complex challenges that strain the system. Methods: We report a thirty-year longitudinal case of G.D.M.: a man initially diagnosed with schizophrenia and later with chronic delusional disorder. Clinical data, forensic assessments, institutional records, and community-based rehabilitation reports were reviewed to reconstruct his clinical, criminological, and forensic trajectory. Results: The patient committed a femicide in early adulthood and, decades later, engaged in stalking behavior toward the victim’s family. Despite prolonged institutionalization, pharmacological treatment, multiple forensic evaluations, and rehabilitation programs, his psychopathology remained substantially unchanged. He persisted with fixed delusional ideation, exhibited minimal insight, and maintained a high level of social dangerousness. Conclusions: This case exemplifies structural gaps in Italy’s forensic psychiatric system, particularly the absence of stratified security levels, long-stay therapeutic facilities, and post-custodial continuity of care for individuals who do not recover. It also highlights the increasing burden placed on the Dipartimenti di Salute Mentale (DSM, Italian Mental Health Departments), which must manage both general psychiatric and high-complexity forensic cases, often without adequate resources or training. Targeted reforms—including secure long-term care pathways, systematic outcome monitoring, and clearer forensic mandates—are needed to ensure proportionate, ethical, and effective management of such cases.

The integration of artificial intelligence (AI) technologies in forensic psychiatry has gained significant attention due to their potential to enhance tasks such as outcome prediction and decision-making. In this study, we explored the feasibility and performance of a large language model (LLM-GPT) in extracting both clinical and non-clinical variables from authentic forensic psychiatric reports concerning defendants' criminal responsibility and social dangerousness. We employed GPT-4o to extract relevant data using a set of custom queries, which we applied to two forensic psychiatric expert reports. The results of the study demonstrated that the system was capable of extracting information from the forensic psychiatric reports and generating a summarized version. Identifying the most important parts to construct a meaningful synthesis in a highly specialized application domain is currently a challenge. This study highlights the potential of AI in forensic psychiatry and suggests that this approach could be valuable for collecting semi-automated or automated data from reports, enabling the creation of a large dataset that could be used for further research and analysis.

Obtaining informed consent in vulnerable populations like children and adolescents, is a relevant issue and raises ethical concerns. Minors are considered unable to consent to treatment, and permission from guardians is required for them. Nevertheless, several studies have been carried out on the competence of pediatric patients, with mixed results. Following PRISMA guidelines, a systematic review was performed to assess children and adolescents’ decisional capacity to consent to treatment. The search strategy identified 2,790 studies, including 10 that survived full-text screening and evaluation. Studies included in the analysis evaluated the decision-making capacity of minors using the MacArthur Competency Assessment Tool - Treatment (MacCAT-T), the Adolescent Psychiatric Patient Competency Questionnaire (CQ-ChP); the Measure of Competency (MOC), the Measure of Competency- Hypothetical (MOC-Hyp). Overall, minors over the age of 13 showed an acceptable decisional capacity. However, further research, preferably on larger groups, is needed to shed more light on this topic.

Although sex and gender differences are well-known in psychiatry, their research in the forensic psychiatric population is still limited. This study is aimed at bridging this gap by examining gender-specific factors and treatment needs among forensic psychiatric patients who are highly dangerous. By retrospectively analyzing data from a 1-year observational study on the Italian Residences for the Execution of Security Measures (REMS) patients (n = 730), we compared the main sociodemographic, clinical, and criminological variables between n = 80 female and n = 650 male patients. Female offenders exhibited a higher prevalence of personality (p < 0.001) and depressive disorders (p < 0.001), as well as more severe crimes leading to REMS admission, notably homicide or attempted homicide (p < 0.05). Furthermore, female offenders had a less frequent history of substance abuse (p < 0.001) than male offenders. Despite these differences, there was no evidence of gender-based differences in different sociodemographic and clinical parameters. This study highlights gender differences in forensic psychiatric patients and underscores the importance of nuanced assessment for implementing tailored interventions in forensic psychiatric care.

ObjectivesTo investigate the effectiveness of treatments approaches in reducing the risk of reoffending in stalking perpetrators.DesignA systematic search was conducted on Medline/Pubmed, CINAHL, PsycINFO, Web of Science, and Scopus.SettingThe United States, United Kingdom, The Netherlands, and Italy.ParticipantsThe analysis included 661 patients with stalking behaviour, 14 (2.1%) of whom were female.TreatmentsThe evaluated treatments encompassed Dialectical Behavioral Therapy (DBT) Acceptance and Commitment Therapy (ACT), Cognitive Behavioral Therapy (CBT), Cognitive Analytic Therapy (CAT), Cognitive-Behavioral Anger Management Intervention, and the Duluth Model as comparison conditions. When pharmacotherapy was present, this, always associated with psychotherapy, was usually based on antipsychotics and mood stabilizers.ResultsWe identified 35 studies from 3141 studies and 10 were included in the systematic review. Psychotherapeutic approaches proved to be effective in reducing recidivism rate, independently from the psychological model employed.ConclusionsPsychological treatments seem to be effective in reducing stalking recidivism, despite further studies are warranted to better elucidate the most effective approaches to deal with this group of offenders, given the severe social repercussions associated with this phenomenon.

The relationship between autism spectrum disorder (ASD) and sexual offending (SO) is an overlooked issue, both in clinical practice and in research. Based on a pre-specified protocol (PROSPERO: CRD42024501598), we systematically searched Pubmed and Scopus, between January 1st, 1994 and January 12th, 2024, for articles related to SO in ASD. Study quality was assessed with study design-specific tools (Study Quality Assessment Tools, NHLBI, NIH). We found 19 relevant publications (five cross-sectional studies, two case-control studies, and 12 case reports). Seven of the studies were deemed of “good” quality, the rest as “fair”. Included studies addressed three key aspects: 1) psychopathological characteristics of individuals with ASD that increase the risk of committing SO; 2) intervention strategies for individuals with ASD and SO; 3) involvement of individuals with ASD and SO in the justice system. Overall, while there is an increasing interest in this topic, more rigorous study designs, including randomised controlled trials, are needed to inform clinical practice and healthcare and social policies.

OBJECTIVE:The primary aim of this study was to conduct a comparative analysis of homicide cases and their perpetrators with psychotic illnesses in Italy and Turkiye, identifying the extent to which country-specific factors influence offender profiles and crime-scene characteristics. METHOD:This cross-national chart review study recruited individuals with psychotic illnesses from forensic psychiatric centers in Italy and Turkiye who were referred for criminal responsibility assessments. Data were collected on the offenders' background characteristics, psychiatric history, victim profiles, and crime-scene details. RESULTS:Compared to the Italian sample, a higher prevalence of hospitalizations, contact with mental health services, and past offending history prior to the index homicide in the Turkish sample highlight inadequate community mental health care and monitoring systems, as well as insufficient supervision by the criminal justice system in Turkiye. Turkish offenders were less likely to exhibit organized crime scenes and post-crime behavior, with fewer stressors preceding the offense, suggesting a greater role of positive psychotic symptoms in their homicidal acts. CONCLUSION:Despite certain similarities, the differences between the two samples highlight the impact of sociocultural, healthcare, and legal systems on offender profiles and crime-scene characteristics. These findings emphasize the need for tailored mental health services, forensic psychiatric assessments and legal supervision that take into account country-specific factors.

Background Hospital falls are a frequent sentinel event worldwide, yet prevention remains challenging. There is a need to standardize hospital fall management in healthcare facilities. This study aimed to analyze policies and procedures used by Italian healthcare facilities to reduce hospital falls. Methods The Italian hospitals’ public procedures on patients’ falls issued between November 2011 and June 2022 were retrieved by a web search using the Google search engine and further evaluated according to their compliance with the 2011 Italian Ministerial recommendation for the prevention of patients’ falls. Results We found 37 official online procedures, of which 45.6% showed full compliance with the 2011 Ministerial recommendation. All the documents explicitly addressed the issue of identifying patient-related fall risk profiles, whereas 28 set appropriate environmental risk factors. More than 80% of the retrieved procedures used the Conley scale. Forty-three percent of the procedures did not provide for national monitoring and reporting of patient falls. Conclusions Public procedures for preventing patient falls in Italian hospitals are scarcely compliant with the 2011 Ministerial recommendation. Local monitoring, compliance, and reporting of hospital falls are needed to improve patient outcomes and reduce the risk of litigation for staff and organizations. Additionally, standardized tools for evaluating the risk of falls, healthcare professionals’ training, and implementing environmental prevention strategies are needed to contrast this issue.

In this way, the issue of consent to health treatment becomes one of the fundamental problems of everyday medical practice, serving as an indispensable link between the physician's power to treat and the patient's personal right to be the manager of his or her own mental and physical health.

Inmates' food refusal is a large-scale phenomenon raising clinical, ethical, and professional responsibility issues. Obtaining a clinical balance of the right to refuse food with the right to protect the inmate's health can be a challenging process. Several reasons may support inmates' choice of refusing food, including political or protest reasons, as well as psychiatric disorders. The World Medical Association defines a hunger striker as a mentally competent person who has indicated his/her decision to go on a hunger strike by refusing to take any food and/or liquid for a significant amount of time. Force-feeding of mentally capable people is not allowed by a legal standpoint, nor medical treatment can be carried out without patients' explicit consent. According to these premises, both the clinical assessment of possible concurrent psychiatric disorders as well as the assessment of inmates' mental capacity to make decisions about refusing food might help in understanding this behavioural issue. We will also discuss the ethical and legal implications related to the right of refusing food according to the current Italian legislation.

Starting in 2015, the Residencies for Execution of Security Measures (REMS) became the place of treatment and care for dangerous offenders who were acquitted due to a mental disorder in Italy. Schizophrenia spectrum disorders (SSD) and personality disorders (PD) are the most common psychiatric disorders among REMS patients. This study aimed to identify and describe potential clinical, therapeutic, and criminal-related differences in REMS patients with SSD and PD. A sample of 528 REMS patients extracted from a previous observational retrospective study underwent secondary analysis. The group of PD patients (n = 150) comprised more females (p < 0.001) and had a higher frequency of substance abuse (p < 0.001) than the SSD group (n = 378). The SSD group was more frequently admitted to the REMS due to homicide/attempted homicide (p < 0.001). Among SSD patients, we found a higher recognition of criminal irresponsibility (p < 0.001). Patients with PD were more likely to engage in violent behavior in the REMS than their SSD counterparts (p < 0.001). Patients with SSD were more likely to receive antipsychotic polypharmacy (p < 0.05) and a higher dose of antipsychotics (p < 0.001). These initial results provide empirical evidence to support the need for personalized forensic treatment paths.

The Italian mafia organizations represent a subculture with values, beliefs and goals that are antithetical to and undermining of the predominant society. The conduct of individual members includes such extreme violence for material gain, it may at least superficially suggest a severe personality disorder. Since the first edition of the DSM and into the 21st century, various terms have been used, sometimes interchangeably, but over time inconsis-tently, to designate the mentality and practices of mafia members. Only recently has the psychology of mafia members become a focus of serious scientific study. Following broader national multicenter research, the present study aimed at investigating the possible differences in psychopathy between those mafia associates who had been convicted only of mafia association (Group A, bosses), and those who were also convicted of violent crimes (Group B, soldiers). The Psychopathy Checklist-Revised (PCL-R) was administered to n = 48 male inmates convicted of mafia association (Mage 45.0 years, SD 10.9, range 20-80 years); Group A consisted of n = 26 (54%) subjects, Group B n = 22 (46%). Most of the sample (73%) did not manifest psychopathy (PCL-R & GE; 25) nor Mann -Whitney U test disclosed significant differences in the total PCL-R scores between the study groups. We found significantly higher scores of PCR-R factor 1 (interpersonal / affective) in the members of the mafia association also convicted of violent crimes (PCL-R F1, group A: 5.8 & PLUSMN; 3.7; group B: 7.9 & PLUSMN; 3.5; p < 0.05), this difference appeared explainable on the basis of a higher component of affective psychopathy. These initial results add to the limited literature on mafia and psychopathy and seem to suggest the existence of a specific component of psy-chopathy in the subgroup of mafiosi with overtly violent conduct.

While denial of pregnancy and neonaticide are rare, they are potentially associated and share some risk factors. Neonaticide has been proposed as the extreme outcome of a denial of pregnancy. However, the process leading to such a possible outcome is not yet fully understood. The primary goal of this essay is to examine the various definitions and ambiguities surrounding the denial of pregnancy. The case of a young woman with a history of two denied pregnancies with diverse characteristics and outcomes, the latest of which resulted in neonaticide, is then reported and examined. A forensic psychiatric evaluation was also performed to reconstruct the woman's mental state at the time of the crime. The forensic pathological analysis of the newborn, abandoned near the sea while still alive, is described. The victim's body showed signs of shaken baby syndrome. We contend that differing levels of awareness during a denial of pregnancy might not be predictive of the potential delivery outcome in terms of threat to the newborn's survival, according to the forensic pathological and psychopathological data of the current case. Early identification of women affected by denial of pregnancy who pose a danger of committing infanticide is hampered by both intrinsic traits (dissimulation, unawareness, low propensity to seek assistance) and environmental factors (isolation, low socioeconomic level, poor education.). A previous history of denial of pregnancy should activate health and support services to reduce the potential risks for the mother and the child.

The possible tendency of subjects to decrease, hide, or omit symptomatic aspects of their mental functioning is one of the main problems in forensic psychological and psychiatric evaluations. We aimed at verifying the possible existence of significant differences in the Millon Clinical Multiaxial Inventory-III (MCMI-III) scales scores between a sample of dissimulators (n = 40) and their non-dissimulator counterpart matched by age, sex, and diagnosis. Cases and comparisons were retrieved from the archive of a single university forensic psychiatric centre between 2013 and 2022. Results showed statistically significant higher scores in the sample of dissimulators in the Desirability, Histrionic, Narcissistic, and Compulsive MCMI-III scales than in the comparison sample. Point biserial correlation test disclosed a strong positive correlation between the Desirability, Histrionic, Narcissistic, and Compulsive scales of the MCMI-III and being in the dissimulator group of subjects while a negative correlation emerged for all the other scales except drug dependence. Key points:The forensic setting can affect a subject's behaviour.Dissimulation is a mechanism of minimization or concealment of a psycho-pathological condition.The MCMI-III can be a useful tool for a forensic psychiatrist or forensic psychologist in assessing dissimulation.

There is a large volume of online crimes. The aim of this work is to reflect on virtual crimes that are apparently different but actually have commonalities. In these cases, the corporeal sphere that mediates interpersonal relationships is absent, and perceptions of the real world and emotional regulation may be altered, which poses the risk of destructive behaviours. From this standpoint, self/hetero-directed aggression is the result of a certain type of transition from the real to the virtual world, where the body either is not involved at all or is experienced in an aberrant manner. In this study, we present three cases that clearly illustrate this concept.

OBJECTIVEThe authors sought to study the transcriptomic and genomic features of completed suicide by parsing the method chosen, to capture molecular correlates of the distinctive frame of mind of individuals who die by suicide, while reducing heterogeneity.METHODSThe authors analyzed gene expression (RNA sequencing) from postmortem dorsolateral prefrontal cortex of patients who died by suicide with violent compared with nonviolent means, nonsuicide patients with the same psychiatric disorders, and a neurotypical group (total N=329). They then examined genomic risk scores (GRSs) for each psychiatric disorder included, and GRSs for cognition (IQ) and for suicide attempt, testing how they predict diagnosis or traits (total N=888).RESULTSPatients who died by suicide by violent means showed a transcriptomic pattern remarkably divergent from each of the other patient groups but less from the neurotypical group; consistently, their genomic profile of risk was relatively low for their diagnosed illness as well as for suicide attempt, and relatively high for IQ: they were more similar to the neurotypical group than to other patients. Differentially expressed genes (DEGs) associated with patients who died by suicide by violent means pointed to purinergic signaling in microglia, showing similarities to a genome-wide association study of Drosophila aggression. Weighted gene coexpression network analysis revealed that these DEGs were coexpressed in a context of mitochondrial metabolic activation unique to suicide by violent means.CONCLUSIONSThese findings suggest that patients who die by suicide by violent means are in part biologically separable from other patients with the same diagnoses, and their behavioral outcome may be less dependent on genetic risk for conventional psychiatric disorders and be associated with an alteration of purinergic signaling and mitochondrial metabolism.