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":"2025-07-01","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":"Unified mental health and capacity law: Creating parity and non-discrimination?","authors":"Jill Stavert,&nbsp;Colin McKay","doi":"10.1016/j.ijlp.2025.102108","DOIUrl":"10.1016/j.ijlp.2025.102108","url":null,"abstract":"<div><div>It has been argued that a fusion of mental health and capacity law creates parity and respects non-discrimination. This approach has been adopted in the Mental Capacity Act (Northern Ireland) 2016, although this legislation is not yet fully in force. Separately the World Health Organisation and the Committee on the Rights of Persons with Disabilities have advocated ending the separate status of mental health law. Across the rest of the UK, the possibility of fusion legislation has recently been considered, although not ultimately recommended in 2018 by the Independent Review of the Mental Health Act for England and Wales and in 2022 by the Scottish Mental Health Law Review. Challenges include potential conflicts with Article 5 of the European Convention on Human Rights, and the Committee on the Rights of Persons with Disabilities' critique of ‘mental capacity’ and whether a capacity threshold is required for unified mental health and capacity law. This article will consider the approach of the Scottish Mental Health Law Review, why it did not recommend immediate fusion and its proposals for greater alignment of mental health and capacity regimes.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"101 ","pages":"Article 102108"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089678","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":"Updating Winterwerp with Rooman to add a requirement for ‘Real therapeutic measures’ to legal criteria for admission without consent in psychiatry","authors":"Brendan D. Kelly","doi":"10.1016/j.ijlp.2025.102087","DOIUrl":"10.1016/j.ijlp.2025.102087","url":null,"abstract":"<div><div>Admission without consent and treatment without consent are topics of prolonged discussion throughout the history of psychiatry. These practices raise significant issues pertaining to human rights to liberty, bodily integrity, and treatment. Balancing rights is always challenging, especially when people lack decision-making capacity owing to the impact of mental illness. In 1979, the European Court of Human Rights outlined criteria required to justify lawful admission without consent owing to mental disorder in <em>Winterwerp v. the Netherlands</em>. These criteria were: (a) a competent national authority needs to demonstrate the existence of a true mental disorder based on objective medical expertise; (b) the extent of the mental disorder needs to warrant compulsory confinement, and (c) continued detention needs to be validated by the persistence of the disorder. Since then, the Court has delivered multiple judgements relating to psychiatric committal and detention in various facilities, but the most significant potential addition to the <em>Winterwerp</em> criteria occurred in 2019, in <em>Rooman v. Belgium</em>. In this case, the Court stated, “that there exists a close link between the ‘lawfulness’ of the detention of persons suffering from mental disorders and the appropriateness of the treatment provided for their mental condition”. The Court stressed ‘that, irrespective of the facility in which those persons are placed, they are entitled to be provided with a suitable medical environment accompanied by real therapeutic measures’. On this basis, this paper proposes adding a fourth requirement to the <em>Winterwerp</em> criteria to justify lawful admission without consent owing to mental disorder: ‘(d) real therapeutic measures must be provided’. The absence of ‘real therapeutic measures’ should undermine the legal basis of admission without consent on the basis of mental disorder. This would mean that there could be no involuntary admission owing to mental disorder without treatment being appropriate and available. Such an addition to criteria for involuntary admission in national mental health legislation would protect, rather than erode, human rights, and would more accurately reflect the core purpose of psychiatry: the treatment of mental illness and the consequent alleviation of suffering.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"101 ","pages":"Article 102087"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143512235","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":"Cognitive biases in forensic psychiatry: A scoping review","authors":"L. Buongiorno ,&nbsp;F. Mele ,&nbsp;G. Petroni ,&nbsp;A. Margari ,&nbsp;F. Carabellese ,&nbsp;R. Catanesi ,&nbsp;G. Mandarelli","doi":"10.1016/j.ijlp.2025.102083","DOIUrl":"10.1016/j.ijlp.2025.102083","url":null,"abstract":"<div><div>Forensic psychiatry plays a critical role in legal contexts but is highly susceptible to cognitive biases that can undermine the accuracy and objectivity of evaluations. This scoping review, guided by the Arksey and O'Malley framework, aims to identify and analyze cognitive biases within forensic psychiatric practice across criminal, civil, and testimonial domains.</div><div>A comprehensive search across five databases yielded 7002 records, with 24 studies meeting the inclusion criteria. From these studies, ten distinct cognitive biases were identified, with the most frequently discussed being gender bias (29.2 %), allegiance bias (20.8 %), and confirmation bias (20.8 %), followed by hindsight, cultural, and emotional biases. Most studies focused on criminal settings, with only two addressing civil contexts.</div><div>Among the mitigation strategies reviewed, structured methodologies and the “considering the opposite” technique were the most positively evaluated and widely discussed approaches. Conversely, the self-awareness strategy was criticized for its limited effectiveness in reducing bias. Emerging tools, such as artificial intelligence, offer potential solutions but require robust ethical safeguards to prevent the perpetuation of systemic biases.</div><div>This scoping review provides a comprehensive overview of the current state of research on biases in forensic psychiatry, underscoring the need for further empirical studies to explore their prevalence, mechanisms, and effective mitigation strategies in greater depth.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"101 ","pages":"Article 102083"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143549041","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":"Criminal legal system contact in fetal alcohol spectrum disorders (FASD): Experiences and support needs","authors":"Martina Faitakis ,&nbsp;Kaitlyn McLachlan ,&nbsp;Christopher Fiacconi ,&nbsp;Katherine Flannigan ,&nbsp;Valerie Temple ,&nbsp;Mansfield Mela ,&nbsp;Jocelynn Cook ,&nbsp;Kathy Unsworth ,&nbsp;Jacqueline Pei","doi":"10.1016/j.ijlp.2025.102106","DOIUrl":"10.1016/j.ijlp.2025.102106","url":null,"abstract":"<div><div>People with fetal alcohol spectrum disorder (FASD) often receive inadequate supports, which can lead to an increased risk of becoming involved in the criminal legal system (CLS). This study compared the needs of people with prenatal alcohol exposure (PAE)/FASD with and without CLS contact and examined patterns of intervention recommendations across groups. Data was drawn from the Canadian National FASD Database and included 544 people with PAE/FASD (<em>M</em> age = 21.1, <em>SD</em> = 8.9, 69.1 % male), matched on age, IQ, and sex, in CLS (<em>n</em> = 272) and non-CLS (<em>n</em> = 272) groups. Several key indicators of CLS contact were identified including having a diagnosis of substance use disorder and experiences of alcohol use/misuse. Recommendations for intervention were more often given for people with CLS contact compared to those without, particularly in respect to mental/physical health and safety needs. Understanding these needs is critical for informing clinical and forensic practice, prevention and intervention planning, and developing and implementing evidence-informed practices to support individuals with FASD.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"101 ","pages":"Article 102106"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144124179","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":"Insanity defense and social dangerousness: A comparative study between China and Italy","authors":"Huan Wan ,&nbsp;Giovanna Parmigiani ,&nbsp;Stefano Ferracuti ,&nbsp;Ping Yan","doi":"10.1016/j.ijlp.2025.102100","DOIUrl":"10.1016/j.ijlp.2025.102100","url":null,"abstract":"<div><div>The determination of criminal responsibility and the evaluation of social dangerousness in the criminal proceedings of offenders with mental disorders are crucial and complex issues. Forensic psychiatric evaluation practices and regulations vary significantly across jurisdictions, offering comparative analysis opportunities. This paper compares the forensic psychiatric evaluation processes in China and Italy, emphatically examining and analyzing the assessment of criminal responsibility and social dangerousness. The shared language, the potential for harmonizing forensic psychiatry practices, and the pursuit of unified and transparent standards and practices underscore the importance of conducting cross-national comparative research.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"101 ","pages":"Article 102100"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143873761","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":"ADHD in adults and criminal behavior: The role of psychiatric comorbidities and clinical and sociodemographic factors in a clinical sample","authors":"Martina Nicole Modesti ,&nbsp;Silvia Gubbini ,&nbsp;Pietro De Rossi ,&nbsp;Agostino Manzi ,&nbsp;Giuseppe Nicolò ,&nbsp;Barbara Adriani ,&nbsp;Simone Pallottino ,&nbsp;Giovanna Parmigiani ,&nbsp;Antonio Del Casale ,&nbsp;Cecilia Guariglia ,&nbsp;Stefano Ferracuti","doi":"10.1016/j.ijlp.2025.102088","DOIUrl":"10.1016/j.ijlp.2025.102088","url":null,"abstract":"<div><h3>Introduction</h3><div>ADHD is a neurodevelopmental disorder associated with functional, behavioral, and relational difficulties. Its onset is in childhood, before the age of 12, and it often persists into adulthood. This study investigates the link between ADHD in adulthood, psychiatric comorbidities, and the risk of criminal behavior, analyzing the impact of clinical and sociodemographic variables.</div></div><div><h3>Methods</h3><div>This cross-sectional study included a sample of 308 patients diagnosed with ADHD, treated at the ADHD Outpatient Clinic of SS Gonfalone Hospital in Monterotondo between 2019 and 2024. Diagnoses and comorbidities were assessed through structured interviews and standardized diagnostic tools (ASRS, DIVA-5). Information on legal status and types of crimes was collected through individual interviews. Statistical analysis was performed using <em>t</em>-tests, chi-square tests, and stepwise logistic regression models.</div></div><div><h3>Results</h3><div>In the sample, 8.1 % of patients with ADHD had committed crimes, with a male prevalence (92 %). Significant predictors of criminal behavior included male gender (OR = 1.899, <em>p</em> = 0.004) and alcohol use disorder (OR = 4.59, <em>p</em> = 0.002). Additionally, oppositional defiant disorder, ADHD diagnosis before the age of 18, and unemployment showed a potential association with risky criminal behavior. Lifetime prescription of antipsychotics (61.4 %) and antiepileptics (48.7 %) was more frequent among participants who committed crimes, while no significant differences were found in the use of atomoxetine and methylphenidate.</div></div><div><h3>Conclusions</h3><div>Adult ADHD, particularly in males, with combined presentation and in the presence of comorbidities such as oppositional defiant disorder and alcohol use disorder, is associated with an increased risk of criminal behavior. The findings highlight the need for personalized and multimodal interventions to mitigate these risks. Future studies should adopt longitudinal designs to explore causal dynamics and evaluate the effectiveness of therapeutic strategies in forensic contexts.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"101 ","pages":"Article 102088"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143549039","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, medical incapacity, and political leadership in the United Kingdom: A multidisciplinary analysis of the intersections between psychiatry and constitutional law","authors":"Alexander J. Smith ,&nbsp;Stefan Theil ,&nbsp;Ashley Weinberg ,&nbsp;Dinesh Bhugra ,&nbsp;Michael Liebrenz","doi":"10.1016/j.ijlp.2025.102109","DOIUrl":"10.1016/j.ijlp.2025.102109","url":null,"abstract":"<div><div>Mental ill-health and medical incapacity in governmental leadership could affect democratic accountability, possibly necessitating complex psychiatric, judicial, and political interactions. Notably, as a prominent democratic jurisdiction, governmental structures in the United Kingdom and the role of its Prime Minister are generally underpinned by constitutional conventions, rather than enforceable legal frameworks. Political continuity and stability thereby rely on the actions and integrity of constitutional agents, which could engender dilemmas if medical incapacity due to mental ill-health becomes evident. Accordingly, based on a critical analysis of relevant legal documents, this paper examines this largely overlooked topic in relation to the office of the United Kingdom's Prime Minister. In doing so, it does not speculate on the mental health of any individual (past or present) and instead explores hypothetical circumstances and constitutional precedents, including the potential for voluntary resignation and involuntary removal, to promote wider knowledge synthesis. Interdisciplinary interpretations are offered for such situations, where constitutional decisions would likely require informal exchanges with mental health specialists and invoke challenges in conducting psychiatric assessments in politically-charged contexts. Finally, to pre-emptively respond to conceivable scenarios and address existing ambiguities, the paper concludes with some interprofessional recommendations aligned with the democratic values of the United Kingdom.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"101 ","pages":"Article 102109"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143941653","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":"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":"2025-05-01","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":"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":"2025-05-01","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}