Motiverande samtal är en metod som kan användas för att hjälpa individer att finna motivation till förändring. Syftet med föreliggande studie är att undersöka hur skötare inom rättspsykiatrin ser på att använda motiverande samtal inom sitt arbete samt hur de använder sig av metoden. Semistrukturerade intervjuer utfördes med informanter som jobbade aktivt med motiverande samtal på en rättspsykiatrisk klinik. Insamlade data analyserades tematiskt vilket resulterade i fem huvudkategorier med grenade underkategorier. Dessa kategorier visade att informanterna använde sig av både riktade motiverande samtal samt använde metodens förhållningssätt utanför dessa samtal. Majoriteten av informanterna uttryckte sig positivt om metoden, med en vilja att fortsätta lära sig om metoden, samt att de gärna ser att fler medarbetare börjar arbeta med metoden. Personlighet uppfattades vara en faktor som inverkade på uppfattad svårighetsgrad av moment inom motiverande samtal. Inga större brister uppfattades angående motiverande samtal utan det var brister som berodde på arbetsplatsen. De fem huvudkategorierna ansågs ge svar på studiens frågeställningar och dessa svar kan i sin tur hjälpa rättspsykiatrin att utveckla sin verksamhet.

Forensic psychiatry in South Africa came to be in the 1970’s following the introduction of the Mental Health Act of 1973 and the Criminal Procedures Act of 1977. Forensic psychiatric units offer psychiatric observation for defendants referred from the courts, as well as providing indefinite detention, for the purpose of treatment and rehabilitation, of those who have been declared unfit to stand trial and/or not criminally responsible due to a mental illness or defect. State patients are mentally ill offenders whose charges involved serious violence. Ultimately these state patients are released back into the community. There is a paucity of South African literature regarding the outcome of state patients.

One of the main problems facing the psychiatrist in forensic psychiatry is the distinction between malingering and mental illness especially in Zulu speaking patients. This study identified twenty items from the literature and clinical practice that separate malingering from mental illness. The validity of these items was assessed through an experimental, cross -sectional study design which compared two groups. These were a sample of fifty malingering African patients, male and female and a control group of fifty mentally-ill African forensic patients who were classified as State Patients. Since the data was categorical, that is, the outcome was either positive (that is malingering) or negative (that is mentally ill) the groups were compared by employing such methods as the chi-square test and Fisher's exact test. Seventeen items we re found to be statistically significant and were regarded as valid items that separate malingering from mental illness. Then the effectiveness of these seventeen items in separating malingering from mental illness was determined by calculating their sensitivity, specificity, their false positive rate and their false negative rate. The items fell into Group four categories or groups. Group I are those three items with a high sensitivity, a high specificity, a few false positives, a few false negatives, high positive predictive values and high negative predictive values. They were able to diagnose both malingering and sickness with a high degree of accuracy. Group 11 consisted of eight items with a high specificity, a few false negatives and high positive predictive values. i1 These items are good at diagnosing malingering patients directly. Group III consisted of six items with a high sensitivity, a few false positives and high negative predictive values. These items are good at diagnosing sick patients and therefore diagnose malingering indirectly by excluding mental illness. Group IV consisted of three items which did not show statistical significance between malingering and mentally ill patients. This study proved that seventeen items were able to separate malingering from mental illness to a statistically significant extent and are effective for the use in the diagnostic assessment of Zulu speaking forensic patients. / Thesis (Ph.D)-University of Natal, Durban, 1997.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2002. / Härtill 5 uppsatser.

<p>Uppsatsen syftar till att ge en allmän beskrivning av den grupp som kommer till rättspsykiatrisk undersökning samt att utreda gruppens förändring över en period på sju år. Variabler som behandlas är kön, invandrarbakgrund, diagnos, brott och påföljd. Uppsatsen som är en kvantitativ studie, kan ses som ett inlägg i debatten kring den allvarligt psykiskt störda brottslingen.</p><p>Uppsatsen är en retrospektiv registerstudie utifrån ett medicinskt kriminologisk perspektiv. Materialet består av 4466 stycken rättspsykiatriska undersökningar mellan åren 1998 och 2004 och inhämtades från Rättsmedicinalverkets centrala arkiv. I resultatet framkommer att personlighetsstörningar i allt mindre utsträckning anses utgöra en allvarlig psykisk störning. Samtidigt blir de allt mindre frekventa som diagnoser inom gruppen. Psykossjukdomar är de diagnoser som i högst utsträckning anses utgöra en allvarlig psykisk störning. Kvinnor bedöms i en klart högre utsträckning än män lida av en allvarlig psykisk störning. Det förekommer ingen skillnad mellan svenskar och invandrare i bedömningen av allvarlig psykisk störning. Dock diagnostiseras invandrare oftare med psykosdiagnoser samt skattas att fungera sämre enligt GAF-skalan. Våldsbrottens andel bland de undersökta har ökat. Dock utgörs det främst av en ökning i hot och misshandel och kan inte påvisas vara relaterat till en ökning i dödligt våld.</p>

Uppsatsen syftar till att ge en allmän beskrivning av den grupp som kommer till rättspsykiatrisk undersökning samt att utreda gruppens förändring över en period på sju år. Variabler som behandlas är kön, invandrarbakgrund, diagnos, brott och påföljd. Uppsatsen som är en kvantitativ studie, kan ses som ett inlägg i debatten kring den allvarligt psykiskt störda brottslingen. Uppsatsen är en retrospektiv registerstudie utifrån ett medicinskt kriminologisk perspektiv. Materialet består av 4466 stycken rättspsykiatriska undersökningar mellan åren 1998 och 2004 och inhämtades från Rättsmedicinalverkets centrala arkiv. I resultatet framkommer att personlighetsstörningar i allt mindre utsträckning anses utgöra en allvarlig psykisk störning. Samtidigt blir de allt mindre frekventa som diagnoser inom gruppen. Psykossjukdomar är de diagnoser som i högst utsträckning anses utgöra en allvarlig psykisk störning. Kvinnor bedöms i en klart högre utsträckning än män lida av en allvarlig psykisk störning. Det förekommer ingen skillnad mellan svenskar och invandrare i bedömningen av allvarlig psykisk störning. Dock diagnostiseras invandrare oftare med psykosdiagnoser samt skattas att fungera sämre enligt GAF-skalan. Våldsbrottens andel bland de undersökta har ökat. Dock utgörs det främst av en ökning i hot och misshandel och kan inte påvisas vara relaterat till en ökning i dödligt våld.

This dissertation study focused upon four stages in the forensic evaluation process, including its impact upon judicial decisions. A group of defendants referred for a pretrial forensic evaluation between October, 1974 and October, 1976 was compared with defendants not referred for evaluation. The results indicated that (1) the defendants referred for forensic evaluation were very similar to those defendants not referred for pretrial examination except that the diverted population was more frequently in custody, remained in custody for a longer time, and remained in the criminal justice system awaiting disposition for a longer time. (2) Factors associated with a recommendation of incompetency and/or insanity included the diagnosis, a poor prognosis, a previous competency evaluation, and past history of hospitalization. (3) Generally forensic competency recommendations were followed by the courts; however, judges were more willing to overrule experts' recommendations of incompetence than competence. When experts agreed the defendent was sane at the pretrial the court followed the recommendation; 1 defendant out of 95 was found insane. When the experts' agreed the defendant was insane at the pretrial evaluation, the defendant was found insane at time of adjudication only 13.5%, though in over 40% of the cases the charges against the defendant were dismissed; still, in nearly half the cases the defendant was found guilty of the crime. (4) The defendants referred and considered competent by the experts were later found guilty and sentenced to prison time more often than defendants who either were not evaluated or considered incompetent by the experts. These diverted but competent defendants received credit less often for time served while in custody than the nonevaluated defendants. Defendants who were considered incompetent by the experts were later less often found guilty, and seldomly sentenced to prison. For these defendants there was a greater likelihood that the criminal charges would be dismissed. However, these defendants were subsequently committed to a mental hospital, and therefore did not "beat their raps." Finally, the greatest likelihood for a not guilty by reason of insanity verdict occurred when previously the experts disagreed as to the competence of the defendant to stand trial.

Bakgrund: Tidigare forskning visar att patienter inom rättspsykiatrisk vård upplever saknad av autonomi, delaktighet och respekt. Det ligger i sjuksköterskans intresse att värna om patientens resurser och planera omvårdnadsarbetet därefter. Genom att arbeta med förbättringsförslag från patienter, anhöriga och vårdpersonal kan vården anpassas efter önskat behov. Syfte: Syftet med denna studie är att utforska områdena delaktighet, vårdrelation, vårdmiljö och bemötande i genomförda PDSA-cykler riktade mot patientens vård i ett kliniskt förbättringsarbete i rättspsykiatrisk vård. Metod: Studien består av två delar, en explorativ kvalitativ design med en induktiv ansats samt en deskriptiv kvantitativ design. Datamaterial från nio enheter samlades in från det redan pågående implementeringsarbetet i den aktuella verksamheten. Kvalitativ innehållsanalys enligt Graneheim och Lundman användes sedan vid analysen av datamaterialet. Resultat: Resultatet har kategoriserats i åtta subkategorier; påverka sin vårdprocess, möjligheten till inflytande, eget ansvar, förbättringar av gemensamma ytor, att skapa en trivsam miljö, stimulans för kropp och själ, ökad kännedom och att tillsammans uppnå uppsatta mål, som senare ledde till fyra huvudkategorier: delaktighet, vårdrelation, vårdmiljö och bemötande Diskussion: Med hjälp av kvalitetsbegreppen trovärdighet, konfimerbarhet, pålitlighet och överförbarhet diskuteras studiens metodavsnitt. Studiens resultat ställs emot tidigare forskning och kopplas även samman med Erikssons teori om vårdandet och vilken betydelse det har i delaktighet, vårdrelation, vårdmiljö och bemötande. / Background: Research has shown that patients in forensic psychiatric care experience a lack of autonomy, participation and respect. It is in the nurse's interest to take care of the patient's resources and to plan the nursing thereafter. Care can be adapted to the desired needs by working with improvement suggestions from patients, relatives and healthcare professionals. Aim: The aim of this study is to explore the areas of participation, care relationship, nursing environment and treatment in implemented PDSA cycles aimed at patient care in a clinical improvement work in forensic psychiatric care. Method: The study consists of two parts, an explorative qualitative design with an inductive approach and a descriptive quantitative design. Data from nine units were collected from the ongoing implementation in the current work. The qualitative content analysis was used according to Graneheim and Lundman in the analysis of the data. Results: The result has been categorized into eight subcategories; implicate the care process, ability to influence, own responsibility, improvement of social areas, creating a pleasant environment, stimulus for body and mind, increased awareness and jointly achieving set goals, which later resulted in four main categories: participation, care relationship, nursing environment and treatment. Discussions: The methodology of the study is discussed using the quality concepts credibility, confidentiality, reliability and transferability. The results of the study are compared to previous research and are also linked to Eriksson's theory of care and its importance in participation, care relationship, nursing environment and treatment.

Evaluations of the Georgia Court Competency Test - Mississippi Version Revised (GCCT-MSH) and the Competency Screening Test (CST) have supported their use with pretrial defendants. The present study evaluated the efficacy of the measures with an inpatient population. Both measures were factor analyzed in an attempt to replicate; previously identified factor structures. Neither factor structure was replicated however, a distinct factor structure was identified for the GCCT-MSH. In addition, the relationship between sociodemographic variables, clinical variables, current symptomatology, and competency status were evaluated using discriminant functions analyses. The results suggest that the best predictors of incompetency in this sample are a diagnosis of a psychotic disorder or a non-psychotic affective disorder and a low measured IQ. Current symptomatology, as measured by the SCL-90-R, was not an effective predictor of competency status in this sample.

Background: Since 2008 there is a law stating that patients who do not require institutional forensic psychiatric care may be moved to non-institutional forensic care, with special conditions. RättspsyK is a national quality register where all of the 25 forensic care units in Sweden collect information about their patients and their care. Previous analysis showed that a considerable amount of patients continue to receive institutional forensic psychiatric care despite they are assessed and found ready to move onto non-institutional forensic care. Aim: The objective of this study was to identify factors affecting why patients were still in institutional forensic care despite assessed to be ready for non-institutional forensic care.Method: First, yearly assessment of each patient between 2009 and 2014 was drawn from the RättspsyK register. Answers to the specific question, Question 10, were analyzed with descriptive statistics and were planned to be used in regression analyses as dependent variable. Result: 1900 patients were included. During analyses the fact that answers to this question were not trustable was found, therefore no exact prevalence of inpatients kept in institutional forensic care despite assessed ready for non-institutional care could be determined. Other information revealed that lack of housing and lack of collaboration were the most frequent reasons for this phenomenon. Conclusion: The present study could not give answer to the original question, but pointed out avalidity problem in the Swedish Forensic Psychiatry Register. The result calls for caution and for the need of validation of RättspsyK register.