Expressing remorse – or not – appears to influence criminal justice outcomes, but preliminary exploration of both judicial and psychological concepts suggests they lack clarity. We asked the following questions: does psychosis impair capacity for, or expression of, remorse for a homicide or other serious harm to others? Is failure to express remorse for an offence associated with recidivism? We conducted systematic reviews of empirical literature on remorse for serious violence while psychotic, and on relationships between remorse and reoffending regardless of mental state. No articles on remorse for homicide or other serious violence while psychotic were identified. There is weak evidence that lack of remorse is associated with reoffending generally, but nothing specific to psychosis. The literature is strong enough to support a case for research into valid measurement of remorse for offending, associations of such measures with recidivism, and whether a change in remorse can be effected – or matters. It is not strong enough to support reliance on perceptions of the presence or absence of remorse as a basis for judicial decisions.

PurposeTilt table testing (TTT) may have a role in the management of vasovagal syncope (VVS), as it may provoke symptoms in patients with suggestive symptoms. We sought to investigate the role of TTT in the management of VVS.MethodsWe conducted a retrospective case-control study of children with VVS symptoms over a 20 year period. We assessed presenting symptoms, disease burden and the appropriateness of TTT. Disease burden was assessed using a scoring system based on frequency of symptoms and psychosocial impact. Patients were identified from an electronic database. Data were analysed using SPSS with chi-square tests and independent t-tests. We rejected the null hypothesis if p- values were less than 0.05.Results50 cases with VVS features who had undergone TTT between 1997 and 2016 were compared to 50 historical controls with VVS but no TTT. The cases were age (p=0.56) and sex (p=0.84) matched. All TTT conducted had an appropriate indication. TTT cases had a significantly higher burden of disease (p=0.03), and were more likely to have pharmacological (p=0.001), and psychological intervention (p=0.02) than controls.ConclusionTTT is a useful tool in the diagnosis of complex cases of VVS. Patients undergoing TTT were more likely to have troublesome symptoms and a higher likelihood of drug and psychological intervention. TTT helped to confirm the diagnosis of VVS and may have enabled treatments to be more targeted and specific.