International Journal of Law and Psychiatry最新文献

{"title":"Large language models and psychiatry","authors":"Graziella Orrù ,&nbsp;Giulia Melis ,&nbsp;Giuseppe Sartori","doi":"10.1016/j.ijlp.2025.102086","DOIUrl":"10.1016/j.ijlp.2025.102086","url":null,"abstract":"<div><div>Integrating Generative Artificial Intelligence and Large Language Models (LLMs) such as GPT-4 is transforming clinical medicine and cognitive psychology. These models exhibit remarkable capabilities in understanding and generating human-like language, which can enhance various aspects of healthcare, including clinical decision-making and psychological counseling.</div><div>LLMs, trained on vast datasets, function by predicting the next word in a sequence, endowing them with extensive knowledge and reasoning abilities. Their adaptability allows them to perform a wide range of language-related tasks, significantly contributing to advancements in cognitive psychology and psychiatry. These models demonstrate proficiency in tasks such as analogical reasoning, metaphor comprehension, and problem-solving, often achieving performance comparable to neurotypical humans. Despite their impressive capabilities, LLMs still exhibit limitations in causal reasoning and complex planning. However, their continuous improvement, exemplified by the enhanced performance of GPT-4 over its predecessors, suggests a trajectory towards overcoming these challenges. The ongoing debate about the “intelligence” of LLMs revolves around their ability to mimic human-like reasoning and understanding, a focal point of contemporary research.</div><div>This paper explores the cognitive abilities of LLMs, comparing them with human cognitive processes and examining their performance on various psychological tests. It highlights the emergent properties of LLMs, their potential to transform cognitive psychology, and the different applications of LLMs in psychiatry, highlighting the limitations, the ethical considerations, and the importance of scaling and fine-tuning these models to enhance their capabilities. We also explore the parallels between LLMs and human error patterns, underscoring the significance of using LLMs as models for human cognition.</div><div>Overall, this paper provides substantial evidence supporting the role of LLMs in reviving associationism as a viable framework for understanding human cognition while acknowledging the current limitations and the need for further research to fully realize their potential.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"101 ","pages":"Article 102086"},"PeriodicalIF":1.4,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143507994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An updated systematic review of the literature on fetal alcohol spectrum disorder and the criminal legal system","authors":"Katherine Flannigan ,&nbsp;Jessica W. Pun ,&nbsp;Pamela Buttinger ,&nbsp;Kaitlyn McLachlan ,&nbsp;Kathleen Holmstrom ,&nbsp;Melissa Tremblay ,&nbsp;Mansfield Mela ,&nbsp;Jacqueline Pei","doi":"10.1016/j.ijlp.2025.102073","DOIUrl":"10.1016/j.ijlp.2025.102073","url":null,"abstract":"<div><div>People with fetal alcohol spectrum disorder (FASD) can experience a range of individual, social, and systemic challenges that may increase the likelihood of life adversity, including contact with the criminal legal system (CLS). The purpose of this article was to update a 2018 systematic review of literature on this intersection of FASD and the CLS. We searched ten academic databases for studies with people with FASD involved in the CLS, as well as caregivers and service providers who support them. A total of 54 studies were identified, published between April 2017 and March 2024, which is more than double what was present in 2018. Most of this research was conducted in Canada and Australia with individuals with FASD across the lifespan. These studies indicate growth in the literature on FASD prevalence in CLS settings (<em>n</em> = 3), CLS-related trajectories for people with FASD (<em>n</em> = 15), the needs and strengths of people with FASD involved in the CLS (<em>n</em> = 9), FASD-informed CLS responses (<em>n</em> = 17), and CLS professional knowledge, attitudes, and practices related to FASD (<em>n</em> = 10). Despite these advancements, there remain limitations in the evidence base such as a lack of specific and rigorous intervention studies; longitudinal research on outcomes and trajectories; generalizable prevalence estimates; the unique ways in which needs, risk, and protective factors may be experienced by people with FASD; how socio-cultural factors impact people with FASD and the research conducted in this area; as well as training opportunities for professionals supporting those with FASD in the CLS. These findings are integrated with results reported in the 2018 review to identify priority areas for future research.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"100 ","pages":"Article 102073"},"PeriodicalIF":1.4,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143454584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stakeholder experiences with compulsory treatment at home: A focus-group study","authors":"D.A. de Waardt ,&nbsp;C.L. Mulder ,&nbsp;G.A.M. Widdershoven","doi":"10.1016/j.ijlp.2025.102072","DOIUrl":"10.1016/j.ijlp.2025.102072","url":null,"abstract":"<div><h3>Background</h3><div>Since 2020, Dutch mental health legislation has provided scope for compulsory treatment at home (CTH). Unlike compulsory community treatment (CCT), CTH allows for the use of compulsion in a patient's home, and thus not only in hospital.</div></div><div><h3>Aim</h3><div>To examine several stakeholders' experiences and views regarding CTH and its implementation.</div></div><div><h3>Methods</h3><div>Four focus-groups were performed: one with patients, one with significant others, one with psychiatrists, and one with a mixed group of stakeholders. The transcripts were analyzed thematically.</div></div><div><h3>Results</h3><div>We identified three themes and 16 subthemes. The first theme concerned the potential benefits of CTH, one of which was avoiding admission to hospital. The second theme focused on preconditions for the delivery of CTH, mainly on communication between mental health workers, patients, and significant others; and the importance of a dialogue well in advance of any compulsory care. With regard to the third theme, considerations regarding the delivery of CTH, all stakeholder groups believed that CTH would be most suitable for patients who had a longer history with their treatment team: between them, they would be able to draw up a plan for compulsory care.</div></div><div><h3>Conclusion</h3><div>Stakeholders felt that CTH can work for patients with a longer treatment history whose home situation allows for treatment at home. They regard an advance dialogue and jointly drawing up a crisis plan as important preconditions. Overall, CTH can be regarded as an extra option for enabling an individually tailored approach.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"100 ","pages":"Article 102072"},"PeriodicalIF":1.4,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Injury degree appraisal of large language model based on retrieval-augmented generation and deep learning","authors":"Fan Zhang ,&nbsp;Yifang Luo ,&nbsp;Zihuan Gao ,&nbsp;Aihua Han","doi":"10.1016/j.ijlp.2025.102070","DOIUrl":"10.1016/j.ijlp.2025.102070","url":null,"abstract":"<div><div>Large Language Models (LLMs) have shown impressive performance in various natural language processing tasks. However, their application in specialized domains like forensic injury appraisal remains challenging due to the lack of domain-specific knowledge and the need for accurate retrieval of relevant information. This study proposes a novel approach that combines Retrieval-Augmented Generation (RAG) with graph-based knowledge bases and deep learning to enable LLMs to conduct injury appraisals based on China’s Standards for Assessing the Extent of Bodily Injuries (SAEBI). We create a dataset of 26,199 real-world injury appraisal cases and develop a RoBERTa-CNN model for accurate classification of injury locations and severity levels. By integrating this model with a graph-based knowledge base, our RAG strategy significantly improves the performance of nine state-of-the-art LLMs in injury appraisal tasks, with accuracy gains ranging from 21 to 59 percentage points compared to traditional retrieval methods. The additional experiments on crime classification also show that our method has good transferability in different domains. Our approach showcases the potential of combining domain-specific knowledge, advanced retrieval techniques, and deep learning to enhance the performance of LLMs in specialized domains like forensic injury appraisal.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"100 ","pages":"Article 102070"},"PeriodicalIF":1.4,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143430342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overview of forensic outpatients on the medical treatment and supervision act in Japan","authors":"Kumiko Ando ,&nbsp;Kanako Nakazawa ,&nbsp;Shota Matsunaga ,&nbsp;Takayuki Okada","doi":"10.1016/j.ijlp.2025.102074","DOIUrl":"10.1016/j.ijlp.2025.102074","url":null,"abstract":"<div><div>In Japan, the Medical Treatment and Supervision Act (MTSA) has been in effect since 2005, and a support system has been established for those found not guilty by reason of insanity (NGRIs). Under this law, the reintegration of the subjects into society is underway. This paper summarizes the status of forensic outpatients during the seven years after its enactment. Information on forensic outpatients was obtained from 224 designated outpatient medical institutions under the law between 2005 and 2011, the period after the law's implementation. Information on demographic factors, psychiatric status, forensic background, clinical treatment history, and social service utilization was collected. Among the 690 outpatients, the most common diagnosis was F2 (Schizophrenia) (76.4 %), and the most common criminal offense was homicide/attempted homicide (28.8 %). Among the outpatients, 46.2 % developed problematic behavior during treatment, and suicidal behavior was observed in 6.0 % of the patients. Since problematic behaviors during treatment, including suicidal behavior, have been observed, it is necessary to expand support, including the development of proper relationships with patients and the early stages of treatment to promote the integration of forensic patients into society.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"100 ","pages":"Article 102074"},"PeriodicalIF":1.4,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143437069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in insanity evaluation. Potential opportunities and current challenges","authors":"Cristina Scarpazza ,&nbsp;Andrea Zangrossi","doi":"10.1016/j.ijlp.2025.102082","DOIUrl":"10.1016/j.ijlp.2025.102082","url":null,"abstract":"<div><div>The formulation of a scientific opinion on whether the individual who committed a crime should be held responsible for his/her actions or should be considered not responsible by reason of insanity is very difficult. Indeed, forensic psychopathological decision on insanity is highly prone to errors and is affected by human cognitive biases, resulting in low inter-rater reliability. In this context, artificial intelligence can be extremely useful to improve the inter-subjectivity of insanity evaluation. In this paper, we discuss the possible applications of artificial intelligence in this field as well as the challenges and pitfalls that hamper the effective implementation of AI in insanity evaluation. In particular, thus far, it is possible to apply only supervised algorithms without knowing which is the ground truth and which data should be used to train and test the algorithms. In addition, it is not known which percentage of accuracy of the algorithms is sufficient to support partial or total insanity, nor which are the boundaries between sanity and partial or total insanity. Finally, ethical aspects have not been sufficiently investigated. We conclude that these pitfalls should be resolved before AI can be safely and reliably applied in criminal trials.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"100 ","pages":"Article 102082"},"PeriodicalIF":1.4,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143430341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental health and sentencing: How are judicial decisions made in light of the judgement of R v Vowles?","authors":"George Baldwin ,&nbsp;Samantha Young ,&nbsp;Lucy Fitton ,&nbsp;Ian Edwards ,&nbsp;Michael Butler ,&nbsp;Peter Beazley","doi":"10.1016/j.ijlp.2025.102071","DOIUrl":"10.1016/j.ijlp.2025.102071","url":null,"abstract":"<div><div>In England and Wales, s.45A of the Mental Health Act 1983 allows a judge to pass a sentence including both an immediate direction to hospital as well as a punitive custodial element. <em>R v Vowles</em> provides four specific considerations for judges to attend to when considering such sentences (referred to as the ‘Vowles statements’). The section, however, remains infrequently used. The present study adopted an online experimental methodology to explore decision-making in relation to the Vowles statements. We used a proxy judicial sample who made decisions about the same criminal case vignette. The experimental manipulation meant that participants were exposed to the same information except for the clinical diagnosis: ‘complex mental health condition’, ‘Emotionally Unstable Personality Disorder’ (EUPD) or ‘Schizophrenia’. Participants were asked to decide which sentence they were most likely to give and rate their agreement with the each of the Vowles statements. Analysis considered relationships between Vowles statements, differences between experimental conditions, and the extent to which different factors (including the Vowles statements) predicted the overall sentencing decision. Results identified that s.45A was, by far, the most common sentencing decision, and that agreement on the different Vowles statements was variable. There was limited evidence of an impact of diagnosis on decision-making, except for some weak evidence that an EUPD diagnosis was associated with marginally higher rates of prison sentences. Most importantly, not all of the Vowles statements were predictive of the final sentence, with attitudes towards the need for punishment having the clearest relationship with the final sentencing decision.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"99 ","pages":"Article 102071"},"PeriodicalIF":1.4,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143376871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"‘If someone had stopped to talk to me’: A human rights analysis of Spain's mental health system","authors":"María Laura Serra","doi":"10.1016/j.ijlp.2025.102069","DOIUrl":"10.1016/j.ijlp.2025.102069","url":null,"abstract":"<div><div>This study explores the gap between Spain's mental health legal framework and the lived experiences of users and survivors of psychiatry, including persons with psychosocial disabilities. Employing a socio-legal methodology, it critically contrasts domestic legislation with qualitative data from interviews, uncovering systemic issues that perpetuate coercive practices such as inadequate judicial oversight and the routine use of coercion and isolation. The findings highlight a significant failure to protect patient autonomy and dignity. This research advocates for comprehensive legal and structural reforms to align Spain's mental health care system with international human rights standards. It underscores the need for a person-centered, rights-based approach that prioritises autonomy, informed consent, and dignity, ultimately promoting a mental health care environment that fully upholds human rights.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"99 ","pages":"Article 102069"},"PeriodicalIF":1.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143324705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is this an underestimated problem? Using coercion before psychiatric hospitalization","authors":"Urszula Zaniewska-Chłopik ,&nbsp;Marcin Zarzycki ,&nbsp;Maria Załuska","doi":"10.1016/j.ijlp.2025.102068","DOIUrl":"10.1016/j.ijlp.2025.102068","url":null,"abstract":"<div><h3>Background</h3><div>The Mental Health Act (1994) specifies rules of use for direct coercion in Poland.</div><div>Coercion in psychiatric wards may improve the safety of patients and surroundings but influences compliance and satisfaction with treatment. Legal (formal) coercion regulated by law isn't the one and only form of coercion used on people with mental disorders. Pressure, threats and orders from relatives and medical staff in relation to procedures of referral and admission to a psychiatric hospital can be described as informal coercion. In Poland there aren't many studies on the use of coercion before psychiatric hospitalization, which justifies the need to conduct this research.</div></div><div><h3>Objectives</h3><div>Assessment of the extent of coercive measures used prior to admission and the relationships between the use of direct coercion and selected demographic-clinical factors.</div></div><div><h3>Material and methods</h3><div>This study was conducted as part of statutory research at the 4th Clinic of the Institute of Psychiatry and Neurology at the Bielanski Hospital in Warsaw from 1.06.13. to 31.05.14. on all the patients admitted to the psychiatric ward in that period. We gathered data on the extent of coercion in the process of hospital referral, and demographic and clinical data was collected. The following tools were used: a specially prepared questionnaire on the extent of the coercion used prior to admission at the hospital, questionnaire on demographic and clinical data, the Brief Psychiatric Rating Scale (BPRS).</div></div><div><h3>Results</h3><div>Coercion prior to admission to the hospital was applied to 53 % of patients, 45 % received informal coercion, and 8 % were physically coerced. Man were more likely to be coerced than women, for people diagnosed with F10-F19 and F20-F29, physical coercion was used more frequently than in patients with other disorders. Patients undergoing informal coercion on the way to the hospital were significantly older than those who weren't exposed on coercion or experienced physical coercion. Higher severity of almost all BPRS subscales (without anxiety and depression subscale) be found in patients who were coerced on their way to hospital than in patients who were not coerced.</div><div>In the analysis of the logistic regression use of coercion prior to admission to the hospital was positively associated with admission without consent, severity of negative symptoms as well as negatively associated with severity of depression symptoms.</div></div><div><h3>Conclusions</h3><div>The high probability of experience coercion before admission to the psychiatric hospital suggests more attention should be paid to procedures connected with referral and transport before psychiatric hospitalization.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"99 ","pages":"Article 102068"},"PeriodicalIF":1.4,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coercive measures in disability and mental health care services: Mechanical restraints from a bioethical and legal perspective in Spain","authors":"Sergio Ramos-Pozón ,&nbsp;Begoña Román-Maestre ,&nbsp;Blas Blánquez","doi":"10.1016/j.ijlp.2024.102067","DOIUrl":"10.1016/j.ijlp.2024.102067","url":null,"abstract":"<div><div>This article explores the use of coercive measures, particularly mechanical and pharmacological restraints, in disability care settings and mental health services from a bioethical perspective, focusing on how these practices impact the human rights of individuals with mental disorder, focusing on how these practices impact the human rights of individuals with mental disorders. A robust bioethical framework is presented, advocating for principles of autonomy, beneficence, non-maleficence, dignity, dialogical justice, distributive justice, and vulnerability. These principles are integrated to reframe interventions and promote respect for patient rights. The article provides a detailed account of the legal framework governing these practices in Spain, addressing both national and regional legislation, and emphasizing its significance in protecting human rights. Finally, practical recommendations are offered, which have proven effective in significantly reducing the need for coercive interventions. The article concludes by advocating for a transformation in clinical practices, promoting dignified and respectful care in line with a human rights framework, and moving away from unnecessary coercive measures.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"99 ","pages":"Article 102067"},"PeriodicalIF":1.4,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}