NGHIEN CUTJ MOT S 6 TRUONG HOP CHAM PHAT TRI^N TAM THAN GAP TRONG GIAM DINH PHAP Y TAM T H A N
Trhn Van Ci^ng Ngo Vdn Vinh
TOM T A T
Cham phdt trien tdm thdn Id mdt nhom trgng thdi benh ly co benh nguyen, b^nh sinh khdc nhau. dgc diem chung la sa sut tdm thdn bdm sinh.
Trong gidm dinh phdp y gap khd nhieu cdc ddi tugng ndy phgm tgi. PhuOng phdp: nghien ciru cua chung tdi Id md td Idm sang cdt ngang. M^c dich cda nghien cuu xdc dinh ddi tugng thiiu ndng tdm thdn ndo gap nhieu nhdt; tinh chat, hdu qud phgm tdi gap a ddi tuxmg ndy. Ket qud: nghien cuu cho thdy:
- Ddi tugng phgm tgi ggp a mue dg thiiu ndng nhe gap 80%, tudi tir 16 - 35 tudi gap 90%.
- Hdnh vi phgm tgi tdi phgm 2 Idn trd len chiem 95%.
Hdu qud phgm tdi tdc hgi nh?
han cdc b^nh ly tdm thdn khdc gdy ra.
SUMMARY
Mental retardation is a group of pathological states, there are differences in etiology and pathogenesis, common characteristics are congenital dementia. In Forensic Psychiatry met many of these objects commit a crime.
Methods and Objectives: Our research method is clinical described cross-sectional.
Research objectives: identifr the object mental retardcOion is seen nwst frequently;
the nature and consequences of crime found in this object.
Results: The study results showed that:
Offenders met in mild disabilities met 80%, aged 16-35 years old met 90%.
Offense recidivism 2 times or more constitute 95%.
Crime consequences milder harm the other mental diseases cause.
I. OAT VAN o6
Chdm phdt triin tdm thdn (CPTTT) la mgt nhdm trang thai bdnh ly cd bdnh nguydn vd bdnh sinh khdc nhau, dac tnmg bdng sy sa sut tam than bdm sinh hoac mac phai trong nhung nam dau thdi tho du, ty Id tu 0,5 din 1,5% ddn so (2). Bieu hien lam sang da dang va phongphu, kdt hgp giira sy thiiu sdt ve CO the'vd nhdng rdi logn tam than cung nhu roi logn ve khd ndng thich ung.
Ngudi benh tin ngudi, de bj dm thj nen dd bj Igi dung, ^ chi yiu, kem ty chu, chinh vi nhung ly do do ma ngudi benh CPTTT chilm khodng 3,40% cac trudng hgp giam djnh (1). De di sdu tim hieu them ve beph CPTTT gdp trong gidm djnh phap y tam thdn (GDPYTT), trong nghidn cdu nay myc dich de ra Id:
Dac dilm Idm sang benh CPTTT gap trong GDPYTT.
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Dgc dilm, tinh ehdt hanh vi pham tdi cua ngudi bdnh CPTTT gap trong GDPYTT.
II. 061 TUONG VA PHirONG PHAP NGHIEN CLTU
I.OoitLPQ'ng
- Cdc cd thi pham phdp do ca quan phdp luat trung cdu giam dinh tai Vien GDPYTT trung uong dugc ch4n dodn xdc djnh Id CPTTT.
S6 lugng: 20 trudng hgp.
2. Phuwng phap nghien ciru Nghidn cuu todn bg hd so gidm dinh do CO quan tnmg cau gidm dinh gdi tdi.
Theo doi, tham khdm lam sang toan di^n va ti mi. Thdi gian luu bj can de theo ddi giam djnh tu 4 din 6 tusin.
- Ldm tk cd cac xet nghidm can Idm sang co bdn va test tri tue Raven hay Weshler.
- Ch^n doan xdc djnh dya vao ICD-10 ndm 1992.
III. K^T QUA VA NHAN XET 1. Phan lo^i theo tuSi
Td 16 din 25 tudi cd 10 trudng hgp, chilm 50%.
Tu 26 din 35 tudi cd 8 trudng hgp, chiem 40%.
Tu 36 din 45 tuoi cd 2 trudng hgp, chilm 10%.
Nhu vdy, gap chu yeu d Ida tuli thanh nien (90%) cd le la phu hgp vi CPTTT la benh xuat hidn vd djnh hinh ngay tir nhung ndm dau cua thdi ky tho
^u, den tuoi thdnh nidn thi nhiing thieu sdt ve ca thi va tdm thdn da rd rdng vd
tin tgi mgt thdi gian khd ddi ndn hg thudng pham tgi d thdi k^ cdn trd tuli.
2. Phan lo^i theo gid^i tfnh - Nam gidi cd 18 trudng hgp, chilm 90%.
NO ^di cd 2 tnrong hgp, chilm 10%.
Dieu ndy cung phu hgp vdi gidi tinh nam Id sy ndng dgng, tfch eye trOi hon so vdi nd. Mdt khdc cdc dii tugng dugc dua tdi gidm djnh Id ngSu nhidn do ca quan trung cau gidm djnh gdi tdi.
3. Ngh4 nghi#p
Khdng nghe nghiep cd 10 trudng hgp, chilm 50%.
Nghe ndng nghi$p cd 10 trudng hgp, chilm 50%.
4. Trinh dp vdn hda
- Khdng bilt chii cd 6 tnrdng hgp, chilm 30%.
Phi thdng ca sd co 14 trudng hgp, chilm 70%.
6 ddy ta thay trinh dg vdn hda cda bdnh nhan rat thap, khdng cd trudng hgp ndo qua dugc phi thdng co sd, ddc biet cd tdi 6 trudng hgp khdng biet chQ'.
Dieu nay la phu hgp vi b$nh CPTTT dnh hudng din tri tu$ cua b$nh nhdn ngay tu nhdng ndm dau tidn trude khi di hgc, khdng thi tiip thu dugc kiln thdc mdi ndn khdng theo hgc dugc.
Cung chinh vi trinh dd vdn hda thap ma hg chi cd nghe nghiep don gidn ho§c khdng the tim dugc nghe nghiep md chi song dyra vdo gia dinh.
5. Phan lo^i nguyen nhdn Khi mang thai m? 6m yeu: 2 (10%).
Bk ngat: 2 (10%).
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Viem mdng nao Ihdi ky Iho 4i: 6 (30%).
Bdnh bai liet: 2(10%).
Khdng xac djnh nguyen nhan: 8 (40%).
Nhu vay cd 12 trudng hgp xac dinh dugc nguydn nhdn gdy ra CPTTT vd chd yeu xay ra d thdi ky tho au cua ngudi bdnh, dieu nay dat ra chg chung ta vin de phdi cd chi do chdm sdc trd em chu dao nhat la vide tidm phdng day dd dl gidm bdt cdc b?nh cd thi gdy ra CPTTT.
6. T|it chirng cv th4 kem theo Ddng nhd bd so vdi lua tuoi: 4 (20%).
Lac mdt: 2 (10%).
Cam diic: 2 (10%).
Gidm van dgng: 1 (5%).
0 day cd tdi m^t nda si trudng hgp cd tdt chiing co thi kdm theo, tuy nhung tat chiing nay khdng tram trgng nhung cung cd tdc ddng xau den cugc sgng sinh hogt vd tinh t h ^ cua bdnh nhdn, gdy ra cho hg cdm gidc ty ti, m^c cdm tu dd cung dd dUn din nhung phdn dng qud mdc, cd khi va cham xieh mich vd dan den pham tdi. V ^ de ddt ra d day Id phdi dilu trj tich eye cac benh ly cd the gidm tdi da cac tat chimg cho benh nhdn.
7. Thuvng s6 tri tu? (IQ)
- IQ td 50 - 70 cd 16 trudng hgp, chilm 80%.
- IQ tCr 35 - 49 cd 4 tnrdng hgp, chilm 20%.
Tat cd cac trudng hgp diu cd thuang si trf tu? d mdc dg yiu (IQ <
70) phu hgp vdi chan dodn tren lam sang. Qua ddy ta thdy vide do thuong so tri tue gdp phan r^t quan trgng. Id yiu tl khdch quan gidp chg vide c h ^ dodn bdnh.
8. Chan doan mirc dg bgnh CPTTT mdc dg nhe cd 16 tnrdng hgp, chilm 80%.
CPTTT mdc dg trung binh cd 4 trudng hgp, chiem 20%.
6 day ta khdng gdp CPTTT mdc dg ndng vd tram trgng ma chi g?p mdc dd nhe vd trung binh, trong dd chu yiu id mdc do nhe. Cd le Id phu hgp vdi nhOng ngudi CPTTT mdc dd n ^ g vd tram trgng thudng kdm theo nhieu tat chiing trdn co thi ndn hoat dgng thy dgng dya vdo sy giup dd cua ngudi khdc, hg khdng cd khd ndng giao tiep xa hOi vl vdy khdng d§n din phgm tgi.
Cdn nhung ngudi CPTTT mdc dd nhe thi hg vin hda nhap cdng dong, tuy nhien khd nang thich ling xa hgi kem, hg rat de bung no phdn ling nen de ddn din phgm t^i. Kit qud ndy cung phd hgp vdi tdi lieu cda mdt si tdc gid khac (3).
9. S6 Idn phgm tgi 4 idn: 4 (20%).
3 lan: 6 (30%).
2 Idn: 6 (30%).
1 \hn: 4 (20%).
So lan pham tdi cua b$nh nhdn chd yeu td 2 \ki trd len 80%. Cd le la phd hgp vi tinh chat b^nh ly cua bdnh nhan CPTTT Id r^t de bj am thi va bj Igi dung, mat khac khd ndng kiim chi cda hg kem ndn khd ndng tai phgm cua hg cung de dang. Van dl ddt ra d ddy la phdi cd ke hogch qudn ly ngudi bdnh chat che dl gidm bdt ty Id tdi phgm cho hg.
10. Hinh thu'c phgm tgi Trdm cdp, cudp giat: 8 (40%).
Dung dao dam chem: 4 (20%).
Hilp dam: 4 (20%).
Dfing cudc ddnh: 2 (10%).
Mdi gidi mai ddm: 2 (10%).
Hinh thdc pham tgi don gidn, it sd dung phuang tien nguy hiem vd hanh vi cung it tdn bge hon so vdi cdc nhdm benh tdm than khdc. 6 day chd yiu Id trdm cdp, cudp giat (40%), chi cd 4 trudng hgp dung dao dam chem trong dd 1 trudng hgp dan din chit ngudi.
Ddng luu y Id cd 4 trong so 20 trudng hgp cd hanh vi hilp dam cdc chdu be 5 - 6 tuoi, trong do cd 2 trudng hgp tai pham, cd thi la do d ngudi bdnh CPTTT hoat ddng tri tue gidm sut ddn din kem dc chd cdc hoat dgng bdn ndng va thieu suy nghT trong hanh vi cua minh.
IV. K^T LUAN
Qua nghien cdu 20 trudng hgp CPTTT pham tgi dugc giam dinh phdp y tdm than tgi Vien Giam dinh Phap y Tam than Tmng uong, chung tdi nit ra mgt so kit lu|n sau:
Do tuli thanh nidn Id chu yeu:
90% tuoi tu 16 din 35.
- Trinh do van hda tii^ (100% chua qua phd thong ca sd) vd nghe nghiep don gian.
Xae djnh dugc dugc nguyen nhan d 12/20 trudng hgp. Dd la nhiing nguyen nhdn lien quan din thdi ky mang thai cua me, thdi ky sinh dd va thdi ky nhu nhi.
- Thuong s6 tri tu? cua benh nhdn thap, khdng cd trudng hgp ndo cd chi si IQ > 70.
Mdc dg CPTTT nh? Id chd yeu (80%).
Khd ndng tdi phgm cua ngudi bdnh CPTTT de ddng.
Hinh thdc pham tdi don gidn.
Hau qud do ngudi b$nh CPTTT pham tgi gdy ra it nghiem trgng han so vdi cdc nhdm bdnh tam th^n khdc.
TAI LIEU THAM K H A O
1. Bg luat hinh sy nude C^ng h6a Xd hgi Chu nghTa Viet Nam.
2. Bg luat tl tyng hinh sy nude COng hda Xa hgi Chu nghTa Vift Nam.
3. Triin Vdn Cirdng (1986): Nhdn xdt kit qud giam djnh phdp y tam than 1970 - 1980. Ndi san tam thk - B?nh vien Tam than Trung uong,
16-23.
4. T r k Vdn C»rdng (2001): Nghidn cdu, phdn tich kit qud d 295 trudng hgp gidm dinh phdp y tdm than tai to chuc gidm dinh phdp y tam than Trung uong trong nhiing ndm qua.
Tai lieu tap huan giam dinh phdp y tdm than - To chdc gidm djnh phdp y tdm th^n trung uong, 46 - 54.
5. Tran Vdn Cu*ng (1992): Nhgn xet 70 trudng hgp hi b?nh tdm than gdp trong giam djnh phdp y tam than cd hdnh vi nguy hilm. Ngi san tam than, th4n kinh, phlu thugt than kinh, BdYtl, 12-18.
Nguyin Ddng Dung (1986): Qudn ly va dieu tri bdnh nhan tdm thdn cd hanh vi nguy hilm cho xd hdi. Tdp san tdm than - Bdnh vien Tam thdn Trung uong, 62 - 67.
Luat bdo vd sue khde nhdn dan cua nude Cong hda Xd hgi Chd nghia Viet Nam ndm 1989.
D u ^ g Khdc Tam (1994): Nhan xdt tinh hinh phgm tgi cda ngudi bdnh tam thiin trgng 2 ndm (1993 - 1994).
Ndi san Bdnh vien Tdm than Bien Hda, 63 - 68.
9. Ngd Van Vinh (2011): Nghien cdu ddc diem ldm sdng va mgt so yeu td thuc ddy hdnh vi phgm tgi d bdnh nhan dgng kinh trgng gidm dinh phdp y tam than. Ludn dn tiin s j y hgc.
10. WHO (1992): Bdng phdn Iggi bfnh qugc te lan thu 10 v l cdc roi loan tdm than vd hdnh vi ICDIO.
