The topic of my diploma thesis is Sexual coercion (section 186 of the Criminal Code) and other crimes against human dignity in the sexual field deals with, besides the fundamental topic of sexual coercion and other crimes, which are mentioned in the third chapter of the special part of Act. No. 40/2009 Coll., Criminal Code. Although these typical sexual offences constitute only a tiny fraction of total criminality, we can label them as the most serious offenses of all, since the consequences they leave for victims are often irreparable. Although the offense of sexual coercion has been introduced into the legal systém for a short time, it has been found in a few cases for a short time and has confirmed that it is very appropriate tool for supplementing rape (§ 185 CC) and sexual abuse (§ 187 CC). The main aim of this thesis is to clarify the facts of the offense sexual coercion, to discuss its object, the physical elements (actus reus), the perpetrator (subject) and the mental elements (mens rea). For this reason, the introductory part is devoted to the historical context and the overall development of sexual offenses in our territory. After this introductory chapter on history, another chapter is dedicated to the current treatment of sexual offenses. The purpose of this chapter is in particular to...

Objetivos. Esta tese vai ao encontro da proposta da psiquiatria do desenvolvimento, investigando sintomas clínicos, fatores de risco e potenciais endofenótipos que possam colaborar com diagnósticos precoces e o desenvolvimento de estratégias de prevenção. Métodos. O primeiro estudo relata a investigação e caracterização de uma amostra de crianças e adolescentes em risco para o desenvolvimento do transtorno obsessivocompulsivo (TOC). Para este propósito, 66 crianças e adolescentes com um familiar de primeiro grau com diagnóstico de TOC tiveram seus dados analisados de acordo com a presença ou ausência de sintomas obsessivocompulsivos. O segundo estudo consistiu no desenvolvimento e testagem de um paradigma dot probe de viés atencional relacionado a sintomas do TOC e na sua investigação enquanto possível endofenótipo do transtorno. Para tanto, três grupos de crianças foram selecionados: crianças com diagnóstico de TOC, em alto risco para o desenvolvimento de TOC (com presença de sintomas obsessivo-compulsivos e história familiar de primeiro grau de TOC) e crianças controle. O paradigma incluiu pares de estímulos aversivos (ativos) e neutros das dimensões de sintomas de contaminação/limpeza e simetria apresentados em 500 ms e 1250 ms. Resultados. O primeiro estudo obteve três resultados importantes. Primeiro, a amostra de crianças com familiar de primeiro grau com TOC apresentou elevada prevalência de sintomas obsessivo-compulsivos, confirmando a familiadade do transtorno. Segundo, crianças com e sem sintomas obsessivo-compulsivos apresentam prevalências diferentes de comportamento coercivo relacionados ou não aos sintomas obsessivo-compulsivos. Terceiro, familiares de crianças com sintomas obsessivo-compulsivos apresentaram mais frequentemente a dimensão de sintomas de contaminação/limpeza do que familiares de primeiro grau de crianças sem sintomas obsessivo-compulsivo. O segundo estudo teve como principais resultados: 1) crianças com TOC apresentam índices mais altos de desconforto pelos estímulos ativos comparados aos dos outros dois grupos de crianças, indicando que o paradigma é eficiente na sua avaliação; 2) a avaliação dos estímulos ativos da dimensão de contaminação/limpeza está associada à presença de seus respectivos sintomas no sujeito; 3) o grupo de crianças com TOC apresentou viés atencional na direção do estímulo aversivo em todas as quatro condições do paradigma (contaminação/limpeza e simetria com 500ms e 1250ms); 4) crianças com TOC apresentaram viés atencional maior do que crianças em risco para o desenvolvimento de TOC e controles sucessivamente, sempre na direção do estímulo aversivo exceto, no paradigma de simetria de 500ms; 5) O viés atencional na direção do estímulo ativo de contaminação no paradigma de 1250ms está associado à presença da dimensão de sintomas de contaminação. Conclusões. Os achados aqui descritos reforçam a familialidade do TOC, contribuem com achados de características associadas ao transtorno na infância e adolescência, reforçam a presença de um marcador de risco importante para o desenvolvimento de estratégias de detecção e prevenção precoces. Os resultados encontrados têm importantes implicações para a melhora do conhecimento de fatores de risco para o desenvolvimento do TOC e características associadas, que devem ser considerados em contextos clínicos e de pesquisa / Objective. This thesis goes in line with the concept of developmental psychiatry investigating clinical symptoms and risk factors that can further provide earlier diagnoses and preventive interventions. Methods. The first study reports the investigation and characterization of a sample of children and adolescents at risk for the development of obsessive compulsive disorder (OCD). For this purpose, 66 children and siblings with a first degree relative diagnosed with OCD had their clinical data analyzed according to the presence of obsessive compulsive symptoms. The second study consisted on the development and testing of an attentional bias dot probe paradigm with OCD relevant content to evaluate pediatric patients with OCD and further investigate it as a possible phenotype of OCD. For this purpose three groups of children were selected: 1) children with OCD; 2) children at risk for OCD (presenting obsessive compulsive symptoms and with a first degree relative diagnosed with OCD); 3) control group (children with none of the Axis I Psychiatric diagnoses). The paradigm included pairs of aversive (active) and neutral stimulus of contamination/cleaning and symmetry symptom dimensions and had two different time presentations of the stimulus, 500 and 1250 milliseconds. Results. The first study had with tree main findings. First, our sample of children with a first degree affected with OCD had a very high prevalence of obsessive-compulsive symptoms, confirming the familiality of the disorder. Second, children with and without obsessive-compulsive symptoms presented different rates of coercive behaviours, that can be related or not to obsessive-compulsive symptoms. Third, first degree relatives of children who had obsessive compulsive symptoms had significantly more contamination/cleaning dimension of obsessive compulsive symptoms than relatives of children without obsessive compulsive symptoms. The second study had the following main findings: 1) children with OCD had higher rates of discomfort caused by active stimulus than the other two groups of children, indicating that the paradigm is efficient for its purpose; 2) the evaluation of active stimulus of the contamination/cleaning dimension is associated to the presence of its respective symptoms; 3) the group of children with OCD had attentional bias towards the active stimulus in all four conditions of the paradigm (cleaning/contamination and symmetry in 500ms and 1250ms); 4) children with OCD had higher attention bias than children at risk and controls always towards the active stimulus with the exception of the 500 ms symmetry paradigm; 5) the attentional bias towards the active stimulus in the 1250 ms contamination paradigm is associated to the presence of symptoms of the contaminations dimension. Conclusions. The results reinforce the familiality of OCD, contributing with findings of associated characteristics to the disorder in childhood and adolescence and reinforcing the presence of an important risk marker for the development of strategies of early detection and prevention. The results have important implications to the improvement of the knowledge of OCD and associated characteristics, which should be considered in clinical and research contexts

A variabilidade comportamental pode ser induzida por reforçamento parcial ou extinção, assim como pode ser reforçada diferencialmente. O objetivo deste estudo foi verificar como a variabilidade comportamental pode ser influenciada por estímulos aversivos, tanto no processo de indução por reforçamento parcial e extinção, como no reforçamento negativo contingente à variação. Oito ratos Wistar machos foram divididos em dois experimentos. Em ambos foram realizadas sessões com 60 choques elétricos de (1mA), administrados no piso da caixa, em VT 60s (10-110s). O objetivo do Experimento 1 foi comparar os níveis de variabilidade da alocação da resposta de focinhar de três sujeitos experimentais em condições de nível operante, reforçamento negativo (fuga) e extinção. No Experimento 2 visou reforçar negativamente a variabilidade comportamental, expondo cinco sujeitos à sessões de Nível Operante, CRF, FR2, LAG1, LAG3 e Acoplado. Os resultados do Experimento 1 demonstram que os sujeitos emitiram a resposta de fuga durante as sessões de CRF com altos índices de variabilidade, mesmo a variabilidade não sendo exigida. Na sessão de extinção, dois dos sujeitos aumentaram ainda mais a variação das respostas. Discute-se que a resposta de focinhar ficou sob controle da contingência operante, enquanto que a sua variabilidade pode ter sido induzida pelo choque ou pelo esquema de reforçamento. Os resultados do Experimento 2 replicam os do Experimento 1 durante as sessões de CRF. Na fase de FR2 houve uma diminuição da variabilidade das respostas, provavelmente em virtude do alto custo da variação da resposta durante a fuga, somado aos efeitos de habituação ao estímulo aversivo. Com a introdução das contingências LAG1 e LAG3, os dados mostraram que os sujeitos aumentaram os índices de variabilidade de acordo com a contingência. Conclui-se que o reforçamento diferencial da variabilidade produziu altos índices de variação. Tais dados estão de acordo com os resultados obtidos com procedimento de reforçamento positivo da variabilidade comportamental em estudos recentes na área, o que sugere a equivalência desses controles. / Behavioral variability can be induced by partial reinforcement or extinction, and be differentially reinforced. The purpose of this study was to investigate how behavioral variability can be influenced by aversive stimuli, both in the process of induction by partial reinforcement and extinction as well as in the negative reinforcement contingent to variation. Eight Wistar male rats were used in two experiments. In both experiments the animals were exposed to 60 electric shocks (1mA) delivered through the box floor, in VT 60s (10-110s). The objective of Experiment 1 was to compare the variability of nose-poke response location of three animals in operant level, continuous negative reinforcement (escape) and extinction. In Experiment 2 five subjects were exposed to sessions of Operant Level, CRF, FR2, LAG1, LAG3 and Yoke condition. Although variability was not required, the results of Experiment 1 revealed that the subjects emitted escape responses with high levels of variation during CRF sessions. In the extinction session, an increase in response variability was found for two subjects. It is argued that the nose-poke response was under control of the operating contingency, while the response variability may have been elicited by shock or the schedule of reinforcement. The results of CRF sessions of Experiment 2 replicate the findings of Experiment 1. During FR2 phase it was detected a decrease in response variability, probably due to the high cost of response variation during escape in addition to the effects of habituation to the aversive stimulus. With the exposure to LAG1 and LAG3 schedules of variation, the data show that the subjects\' variability levels increased according to the contingency in effect. The differential reinforcement of variability resulted in high levels of variation. These data match the results of recent studies on the influence of positive reinforcement procedures on behavioral variability, what suggests the equivalence of these controls.

No description available.

Este estudo transversal avaliou a capacidade para a tomada de decisões, e a percepção de coerção, de pacientes internados em cuidados paliativos e seus acompanhantes, bem como a qualidade de vida dos pacientes. Foram estudados 89 pacientes oncológicos internados no Núcleo de Cuidados Paliativos do Hospital de Clínicas de Porto Alegre e 88 acompanhantes. Apenas entre os pacientes, os homens tiveram idade significativamente superior à das mulheres (F=3,97; P=0,049). A escolaridade foi igual nos dois grupos, com média de 8 anos de escola. Tanto os pacientes quanto os acompanhantes demonstraram ter capacidade para tomar decisões em seu melhor interesse. Nos domínios do WHOQOL-OLD, a Participação social teve a menor média enquanto que a Intimidade foi o melhor. Nos domínios do WHOQOL-BREF, a Saúde Física teve a menor média, sendo o Meio ambiente o de melhor desempenho. Este estudo evidenciou que tanto pacientes quanto familiares apresentaram capacidade para tomar decisões em seu melhor interesse, e que a decisão de transferência à unidade de cuidados paliativos foi compartilhada entre os pacientes, profissionais e acompanhantes, havendo baixa coerção percebida. Os pacientes demonstraram-se satisfeitos com a capacidade de estabelecer relações sociais, pessoais e íntimas, mesmo estando internados. / This cross-sectional study assessed the decision making capacity and the perception of coercion of inpatients admitted to palliative care and their escorts, as well the patients’ quality of life. There were included in the study 89 cancer patients admitted to the Center for Palliative Care at Hospital de Clinicas de Porto Alegre and 88 escorts. Only between patients, men had significantly higher age than females (F = 3.97, P = 0.049). Education level was similar in both groups, averaging 8 years of school. Both the patients as the escorts have demonstrated the ability to make decisions in their best interest. In areas of WHOQOL-OLD, Social participation had the lowest average, while Intimacy was the best one. In WHOQOL-BREF domains, the Physical health had the lowest average, and the Environment had the best performance. This study showed that both patients and escorts showed capacity to decide in their best interest, and the decision involved in patient admission to the Center of Palliative Care was shared between patients, health professionals and escorts, with low perceived coercion. The inpatients showed their satisfaction with the capability to establish social, personal and intimate relationships, even while hospitalized.

A variabilidade comportamental pode ser induzida por reforçamento parcial ou extinção, assim como pode ser reforçada diferencialmente. O objetivo deste estudo foi verificar como a variabilidade comportamental pode ser influenciada por estímulos aversivos, tanto no processo de indução por reforçamento parcial e extinção, como no reforçamento negativo contingente à variação. Oito ratos Wistar machos foram divididos em dois experimentos. Em ambos foram realizadas sessões com 60 choques elétricos de (1mA), administrados no piso da caixa, em VT 60s (10-110s). O objetivo do Experimento 1 foi comparar os níveis de variabilidade da alocação da resposta de focinhar de três sujeitos experimentais em condições de nível operante, reforçamento negativo (fuga) e extinção. No Experimento 2 visou reforçar negativamente a variabilidade comportamental, expondo cinco sujeitos à sessões de Nível Operante, CRF, FR2, LAG1, LAG3 e Acoplado. Os resultados do Experimento 1 demonstram que os sujeitos emitiram a resposta de fuga durante as sessões de CRF com altos índices de variabilidade, mesmo a variabilidade não sendo exigida. Na sessão de extinção, dois dos sujeitos aumentaram ainda mais a variação das respostas. Discute-se que a resposta de focinhar ficou sob controle da contingência operante, enquanto que a sua variabilidade pode ter sido induzida pelo choque ou pelo esquema de reforçamento. Os resultados do Experimento 2 replicam os do Experimento 1 durante as sessões de CRF. Na fase de FR2 houve uma diminuição da variabilidade das respostas, provavelmente em virtude do alto custo da variação da resposta durante a fuga, somado aos efeitos de habituação ao estímulo aversivo. Com a introdução das contingências LAG1 e LAG3, os dados mostraram que os sujeitos aumentaram os índices de variabilidade de acordo com a contingência. Conclui-se que o reforçamento diferencial da variabilidade produziu altos índices de variação. Tais dados estão de acordo com os resultados obtidos com procedimento de reforçamento positivo da variabilidade comportamental em estudos recentes na área, o que sugere a equivalência desses controles. / Behavioral variability can be induced by partial reinforcement or extinction, and be differentially reinforced. The purpose of this study was to investigate how behavioral variability can be influenced by aversive stimuli, both in the process of induction by partial reinforcement and extinction as well as in the negative reinforcement contingent to variation. Eight Wistar male rats were used in two experiments. In both experiments the animals were exposed to 60 electric shocks (1mA) delivered through the box floor, in VT 60s (10-110s). The objective of Experiment 1 was to compare the variability of nose-poke response location of three animals in operant level, continuous negative reinforcement (escape) and extinction. In Experiment 2 five subjects were exposed to sessions of Operant Level, CRF, FR2, LAG1, LAG3 and Yoke condition. Although variability was not required, the results of Experiment 1 revealed that the subjects emitted escape responses with high levels of variation during CRF sessions. In the extinction session, an increase in response variability was found for two subjects. It is argued that the nose-poke response was under control of the operating contingency, while the response variability may have been elicited by shock or the schedule of reinforcement. The results of CRF sessions of Experiment 2 replicate the findings of Experiment 1. During FR2 phase it was detected a decrease in response variability, probably due to the high cost of response variation during escape in addition to the effects of habituation to the aversive stimulus. With the exposure to LAG1 and LAG3 schedules of variation, the data show that the subjects\' variability levels increased according to the contingency in effect. The differential reinforcement of variability resulted in high levels of variation. These data match the results of recent studies on the influence of positive reinforcement procedures on behavioral variability, what suggests the equivalence of these controls.

<p>Det är sjuksköterskans ansvar att etablera en vårdrelation där patienten känner sig trygg, därför var det viktigt att belysa patientens egen uppfattning om vårdrelationens innebörd och vad det kan ha för betydelse för omvårdnaden. Syftet med studien var att undersöka vårdrelationens innebörd för vuxna patienter inom psykiatrisk tvångsvård. Studien är litteraturstudie med kvalitativ och deskriptiv design. Det gjordes en artikelsökning i Cinahl och PubMed med sökorden psychiatric care, caring relationship, coercion samt patients experiences. Artiklarna som valdes ut kvalitetsgranskades och sedan gjordes en manifest innehållsanalys. Den resulterade i sex kategorier: att känna sig åsidosatt, förlorat människovärde, maktlöshet, att bli tagen på allvar, medmänsklighet samt delaktighet. Därefter gjordes en tolkning av det manifesta innehållet, dvs. en latent innehållsanalys, där urskiljdes två teman: ensidighet och ömsesidighet. Patienterna beskrev antingen att de upplevde en distans från vårdarna eller att vårdarna bemötte dem på ett jämlikt plan. Eftersom patienterna är i en beroendeställning inom psykiatrisk tvångsvård blir relationen ojämn (asymmetrisk). En ömsesidig vårdrelation kan ses som en moralisk norm som banar väg för upprättandet av en vårdgemenskap.</p> / <p>It is the nurse's responsibility to establish a caring relationship in which the patient feels safe, therefore it was important to highlight the patient's own perception of the caring relationship and what it means to caring. The aim of this study was to investigate the meaning of the caring relationship for adult patients in compulsory psychiatric treatment. The study was a literature review with qualitative and descriptive design. The search for scientific articles was done by the databases in Cinahl and PubMed with the keywords psychiatric care, caring relationship, coercion, and patient experiences. The selected articles were quality reviewed and then a content analysis of the manifest content was made which resulted in six categories: to feel disregarded loss of dignity, powerlessness, to be taken seriously, humanity and participation. Thereafter, an interpretation of the manifest content, i.e. a latent content analysis was made. Two themes were discerned: one-sidedness and mutuality. Patients described either that they experienced a distance from the health personal or that they responded to them on an equal plane. Since patients are in a dependent position in compulsory psychiatric treatment relationship becomes uneven (asymmetrical). A mutual caring relationship can be seen as a moral standard that paves the way for the establishment of a community.</p>

The use of coercion in psychiatry involves clinical, legal, scientific, ethical and emotional considerations. This thesis represents an attempt to further increase our understanding of some empirical aspects of this phenomenon. Interviews with 202 involuntarily admitted psychiatric patients and 201 voluntarily admitted patients and 295 of their next of kins were performed and analysed together with data from records and assessments made by professionals. Data was collected during two different periods of time with a compulsory psychiatric care law reform in between. Experience of at least one coercive measure was more common amongst patients who had been committed during the most recent legislation. Otherwise there were no differences in patient experiences during the different laws. Subjective short-term outcome was associated with having a contact person at the ward and being subjectively treated well. There were no relationships between subjective and assessed outcome or between legal status, perceived coercion at admission and subjective or assessed improvement. The changed legislation had no clear effect on the attitudes of patients and next of kins towards coercion. A majority of patients were able to accurately answer the question whether they had been restrained by belt or not during a specific treatment episode. Nineteen of 115 patients reported they had been restrained by belt. Eleven of these cases were true positive and 8 cases were false positive. In conclusion, the main results were first that when it comes to issues related to psychiatric coercion there are typically considerable differences between how these are perceived and interpreted by the professional and by the patient, and second that efforts made to change the face of psychiatric coercion in the minds of patients as well as the public on part of public policymakers have had limited effects.

Det är sjuksköterskans ansvar att etablera en vårdrelation där patienten känner sig trygg, därför var det viktigt att belysa patientens egen uppfattning om vårdrelationens innebörd och vad det kan ha för betydelse för omvårdnaden. Syftet med studien var att undersöka vårdrelationens innebörd för vuxna patienter inom psykiatrisk tvångsvård. Studien är litteraturstudie med kvalitativ och deskriptiv design. Det gjordes en artikelsökning i Cinahl och PubMed med sökorden psychiatric care, caring relationship, coercion samt patients experiences. Artiklarna som valdes ut kvalitetsgranskades och sedan gjordes en manifest innehållsanalys. Den resulterade i sex kategorier: att känna sig åsidosatt, förlorat människovärde, maktlöshet, att bli tagen på allvar, medmänsklighet samt delaktighet. Därefter gjordes en tolkning av det manifesta innehållet, dvs. en latent innehållsanalys, där urskiljdes två teman: ensidighet och ömsesidighet. Patienterna beskrev antingen att de upplevde en distans från vårdarna eller att vårdarna bemötte dem på ett jämlikt plan. Eftersom patienterna är i en beroendeställning inom psykiatrisk tvångsvård blir relationen ojämn (asymmetrisk). En ömsesidig vårdrelation kan ses som en moralisk norm som banar väg för upprättandet av en vårdgemenskap. / It is the nurse's responsibility to establish a caring relationship in which the patient feels safe, therefore it was important to highlight the patient's own perception of the caring relationship and what it means to caring. The aim of this study was to investigate the meaning of the caring relationship for adult patients in compulsory psychiatric treatment. The study was a literature review with qualitative and descriptive design. The search for scientific articles was done by the databases in Cinahl and PubMed with the keywords psychiatric care, caring relationship, coercion, and patient experiences. The selected articles were quality reviewed and then a content analysis of the manifest content was made which resulted in six categories: to feel disregarded loss of dignity, powerlessness, to be taken seriously, humanity and participation. Thereafter, an interpretation of the manifest content, i.e. a latent content analysis was made. Two themes were discerned: one-sidedness and mutuality. Patients described either that they experienced a distance from the health personal or that they responded to them on an equal plane. Since patients are in a dependent position in compulsory psychiatric treatment relationship becomes uneven (asymmetrical). A mutual caring relationship can be seen as a moral standard that paves the way for the establishment of a community.

Women’s use of aggression in intimate partner relationships is consistently debated by researchers of intimate partner aggression. One tenet suggests women use aggression within intimate relationships at similar rates as men. Conversely, a second tenet acknowledges women’s use of aggression but suggests that the meaning and consequences associated with women’s aggression is not coercive or severely injurious, which are typical characteristics of men’s use of aggression. The current study evaluated incarcerated women in order to build upon an integrative approach that suggests that women’s use of aggression is related to the relationship dynamics generated from variations in coercive and conflictual behaviors. Further, the current study evaluated the moderating relation of childhood abuse history and posttraumatic stress symptoms between relationship dynamics and women’s use of aggression. Ninety-six women, who participated in a larger research project that investigated incarcerated women’s life experience, reported on the dynamics of their most recent abusive heterosexual relationship, their own use of aggression (minor and severe) and childhood abuse history and posttraumatic stress symptoms. Findings suggest that incarcerated women involved in intimate relationships characterized as highly conflictual use significantly more minor and severe aggression toward their partners than women involved in relationships with low levels of conflicts. The finding is significant regardless of the level of coercion present in the relationship. Lastly, neither childhood abuse history nor posttraumatic symptoms moderated the relation between intimate partner relationship dynamics and women’s use of aggression. Various reasons for the lack of support for the moderating effect of history on women’s use of aggression are discussed.