Personality traits in suicidal and homicidal subjects with schizophrenia

Paranoid schizophrenia is characterised by an increased risk of suicide and homicide. Little is known about the influence of personality dimensions as determinants for suicidal and homicidal behaviour within this condition. We assessed the differences among suicidal, homicidal and non-aggressive adult male in-patients with ICD-10 paranoid schizophrenia. The clinical assessments included structured psychiatric interviews and reports on harmful alcohol use and suicide attempts. The personality dimensions were assessed with the Big Five Inventory-10. The study recruited 264 patients divided into three groups: suicide attempters (N = 62), homicide group (N = 70), and a comparative control group (N = 132). To examine how the clinical subgroups differed from the comparative sample in the studied variables, a multinomial regression was performed. Each subgroup was considered a nominal outcome variable and the log odds of the outcomes were modelled as a linear combination of the predictor variables. Neuroticism or emotional instability was the only personality dimension that was different among the study subgroups: a lower level of neuroticism was found in the homicide group. Other risk factors such as age, education, relationship status and history of self-aggressive behaviour could potentially distinguish these subgroups of paranoid schizophrenia patients.     

Filicide, attempted filicide, and psychotic disorders

The objective of the study was to describe and discuss the cases of two women who faced criminal charges, one for attempting to murder her three children and the other for killing her 1-year-old boy. After a forensic psychiatric assessment of their level of criminal responsibility, these patients were considered not guilty by reason of insanity and were committed to forensic mental hospitals. These two patients received a diagnosis of paranoid schizophrenia, according to the DSM-IV-TR criteria. In both cases, psychotic symptoms were present before the manifestation of violent behavior, in the form of persecutory delusions, auditory hallucinations, and pathological impulsivity. The investigation into cases of filicide may contribute powerfully to expand our understanding of motivational factors underlying this phenomenon and enhance the odds for effective prevention.     

The relationship of compliance with anxiety,self-esteem,paranoid thinking and anger

Abstract

The aim of the study was to assess the relationship of compliance with anxiety, self-esteem, paranoid thinking, and anger. The Gudjonsson Compliance Scale (GCS), the State-Trait Anxiety Inventory (STAI), the Rosenberg Self-Esteem Scale, the Paranoia/Suspiciousness Questionnaire (PSQ), and the Novaco Anger Scale (NAS) were administered to 167 University students Compliance correlated positively with state and trait anxiety, low self-esteem, paranoia and suspiciousness, and negatively with acting out feelings of anger (the Behavioural Domain of the NAS). Multiple regression of the test scores showed that paranoid thinking was the single best predictor of compliance. The implications are discussed. It is important to replicate the study on special populations, such as offenders and psychiatric patients, who have problems with low self-esteem, paranoid thinking, and anger.     

Seclusion: the association with diagnosis,gender, length of stay and HoNOS-secure in low and medium secure inpatient mental health service

The use of seclusion is controversial. Using routinely collected data from low and medium secure service provider in the United Kingdom (n = 347) this study compared secluded and non-secluded Asperger’s syndrome, paranoid schizophrenia, organic personality disorder and emotionally unstable personality disorder patients. Analysis revealed that secluded patients were younger but did not differ on length of stay. Scores on the HoNOS-secure improved from entry to discharge on all diagnostic categories, indicating sensitivity to change. However, secluded patients with paranoid schizophrenia did not improve on the secure scale or personal and emotional well-being sub-scale factors, indicating HoNOS-secure should be used with caution in discharge decisions. Findings indicate that HoNOS-secure do not capture the factors linked to the use of seclusion in organic personality disorder and Asperger’s syndrome. HoNOS secure results outline differing needs and progress in the four diagnostic groups. Seclusion did not affect recovery as measured by HoNOS-secure clinical scale, providing evidence opposing the view that seclusion plays a major contribution to delaying recovery.     

Psychopathy,intelligence, and impulsivity in German violent offenders

Previous studies have reported numerous correlations between psychopathy and various personality traits, behavioural tendencies or clinical characteristics. The present study examined in greater depth the relationships between the components of psychopathy as measured by the Psychopathy Checklist—Revised (PCL-R) and intelligence as well as impulsivity. A total of ninety male violent offenders were recruited from a prison and a forensic–psychiatric hospital in Germany. All of the subjects were assessed using the PCL-R, the Barratt Impulsiveness Scale (BIS-11), and a short version of the German Wechsler Adult Intelligence Scale (WIP). As expected, a canonical correlation analysis showed a negative association between spatial intelligence and the Factor 2 subtotal on the PCL-R (reckless lifestyle/antisociality). In addition, our results agreed with the assumption of an association between impulsivity and the subtotal for PCL-R Factor 2. The positive relationship between verbal intelligence and the subtotal for Factor 1 of the PCL-R (insincere, manipulative conduct/affective deficits) vanished after controlling for educational level. The results indicate that there is a relationship between the spatial components of intelligence and the concept of psychopathy as described by Hare. This result supports the spatial impairment aetiological model of antisocial behaviour.     

Evaluation of a cognitive-behavioral program for chronically psychotic forensic inpatients

The present study evaluated the progress of four groups of chronically psychotic patients in treatment at De Kijvelanden Forensic Psychiatric Hospital. The psychotic patients were offered a cognitive-behavioral program, including psycho education, grief processing, stress management, functional training, coping with psychotic symptoms (Liberman module) and social skills training. Nine patients dropped out of the program. Sixteen patients who completed it scored significantly better than a control group of 16 psychotic patients, who had not yet participated in the program, on the "social skills" and "negative coping behavior" subscales of one of two observation scales used. On the other observation instrument (REHAB), however, no significant improvement in the general level of functioning was found in the group of treated patients, as compared to the control group. Apart from these two observation scales, the PANSS (structured interview for positive, negative and general psychopathological symptoms) and the SIG (self-report questionnaire for social anxiety and social responses) were used to evaluate treatment progress. Significant improvements were not found on these scales, except for a slight positive effect on the PANSS negative symptoms scale. These results illustrate the difficulties and limitations of treating chronically psychotic offenders, who often also suffer from cluster B personality disorders.     

Testing a Theoretical Model of the Relationship Between Impulsivity,Mediating Variables,and Husband Violence

The present study involved a multimethod assessment of impulsivity among 86 men. Using two questionnaires and four performance-based measures of impulsivity, the factor structure of the impulsivity data was examined. Four constructs that theoretically mediate the relationship between impulsivity and husband violence (i.e., substance abuse, anger/hostility, marital dissatisfaction, and psychological abuse) were assessed to examine a mediational model predictive of husband violence. Substance abuse and marital dissatisfaction mediated the relationship between impulsivity and psychological abuse. Psychological abuse mediated the relationship between substance abuse and marital dissatisfaction and husband violence. Although anger/hostility was not a mediator, there were bivariate associations between anger/hostility and impulsivity, psychological abuse, and husband violence. The results of the regression analyses were virtually identical when controlling for the effect of intelligence on the model variables. The implications of the findings for the assessment of impulsivity and for future husband violence research are discussed.     

Assessment of the Capacity to Express Informed Consent for Organ Donation in Patients with Schizophrenia

Abstract: In Italy, the “silent‐consent” principle of donor’s willingness regulates organ donation for postmortem transplantation, but civil incompetence excludes it. We investigated decisional capacity for organ donation for transplantation of 30 controls and 30 nonincompetent patients with schizophrenia as related to clinical symptoms, cognition, and functioning. Assessments were carried out through the Competence for Donation Assessment Scale (CDAS), Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms, Life Skills Profile (LSP), Raven’s Colored Progressive Matrices (RCPM), Wisconsin Card Sorting Test, Rey RI, Rey RD, and Visual Search. Patients and controls differed on the CDAS Understanding and Choice Expression areas. Patients showed significant inverse bivariate correlations between CDAS Understanding and scores on total BPRS, LSP self‐care scale, and RCPM cognitive test. Our results show that decisional capacity for participating in research does not predict decisional capacity for postmortem organ donation in patients with schizophrenic or schizoaffective psychosis; hence, before judging consent for donation, patients must be provided with enhanced information to better understand this delicate issue.     

"Theory of Mind" and Executive Functioning in Forensic Patients with Schizophrenia

Abstract:  Previous studies in forensic patients with schizophrenia have shown that delinquent patients may outperform nondelinquent patients with regards to "theory of mind" (ToM). Findings were, however, confounded by a lack of control for executive functioning. We examined 33 forensic patients with schizophrenia regarding ToM, intelligence, executive functioning, and psychopathology. Results were compared with a nonforensic schizophrenia sample and a group of healthy controls. Both patient groups performed more poorly on most measures compared with controls. Forensic and nonforensic patients did not differ in task performance. In the forensic group ToM correlated inversely with "excitement" and cognitive symptoms. When "excitement" was covaried out, forensic patients outperformed nonforensic patients with regards to ToM. This study supports the hypothesis that schizophrenic patients with a criminal record are equally impaired in their ability to infer mental states compared with nonforensic patients, but for different reasons associated with a divergent psychopathological profile.     

Personality predictors of self-reported offending in Icelandic students

Abstract

The purpose of this study was to investigate the relationship between self-reported offending and personality. A total of 1603 students in further education in Iceland completed the Mak Self-Reported Delinquency Scale as well as a number of psychological tests, namely the Eysenck Personality Questionnaire (EPQ and IVE), the Gough Socialisation Scale, the Rosenberg Self-Esteem Scale, and the Gudjonsson Compliance Scale. Multiple regression analyses showed that five out of the 10 individual personality scales contributed 27 and 30 per cent to self-reported offending for males and females, respectively. Overall, the Gough Socialisation Scale and EPQ psychoticism contributed most to the variance in self-reported offending, but impulsivity, extraversion and a low lie score also added significantly to the variance after interactions among the personality measures had been taken into account. Some gender differences emerged with impulsivity being a better predictor of offending among the males than females. Overall, the findings give strong support for the hypothesis that personality, particularly those relating to antisocial personality traits, is significantly related to self-reported offending in both males and females.     

Impulsivity,attribution and prison bullying: Bully-category and perpetrator–victim mutuality

The current study explores bullying behaviours among adult male prisoners, examining its relationship with aggression attribution and impulsivity. Employed are two separate methods of analysis to determine how this may influence results. Participants were 102 prisoners. All completed a revised version of the Direct and Indirect Prisoner behaviour Checklist (DIPC-R), the Barratt Impulsivity Scale: Version II (BIS-12) and the Expressive Aggression Scale (EXPAGG). Analysis included categorical analysis with prisoners placed into one of four groups (pure bully, pure victim, bully/victim and not-involved), and factorial analysis where perpetration and victimisation were assessed as continuous variables and evidence of interactions explored. It was predicted that perpetration would be associated with higher instrumental attributions and higher impulsivity than non-perpetration. It was predicted that a factorial analysis would demonstrate no interactions between perpetration and victimisation across aggression variables, questioning the utility of a distinct ‘bully–victim’ group. Bullies were found to have higher instrumental attribution scores than non-bullies, with no differences for expressive attribution. Victims were more impulsive than non-victims with evidence that perpetration moderated this relationship. A categorical analysis demonstrated that bully/victims were more impulsive, at least in relation to pure bullies. Results suggested that it was the combined effect of indirect and direct aggression which promoted differences between victims and bullies in relation to attribution and impulsivity. Results are discussed with reference to previous research concerning prison bullying, with directions for future research focused on exploration of perpetrator–victim mutuality using a range of variables and distinct methods of analysis.     

Prevalence of delusional jealousy in psychiatric disorders

Delusional jealousy is a known risk factor for violence and homicide, but little is known about its prevalence in psychiatric disorders. We therefore reviewed retrospectively the psychopathological symptoms at admission and discharge, assessed with the AMDP system, of all patients admitted to the Psychiatric Hospital, University of Munich, Germany, from January 2000 through December 2008 (n=14,309). We identified 72 cases of delusional jealousy (0.5% of the whole sample). The prevalence was highest in schizophrenia and other psychoses (1.3%), and more of the patients with delusional jealousy were men (43 of 72, 59.7%). One-fifth (15 of 72, 20.8%) of the patients with delusional jealousy were aggressive at admission (vs. 6.2% of the total sample). We conclude that delusional jealousy is a comparatively rare phenomenon that is most frequent in schizophrenia and related psychoses. Quite a number of affected patients are aggressive, which may indicate a risk of future violence.     

Alternative Pathways to Violence in Persons with Schizophrenia: The Role of Childhood Antisocial Behavior Problems

Violence in schizophrenia patients may result from many factors besides the symptoms of schizophrenia. This study examined the relationship between childhood antisocial behavior and adult violence using data from the NIMH CATIE study. The prevalence of violence was higher among patients with a history of childhood conduct problems than among those without this history (28.2% vs. 14.6%; P < 0.001). In the conduct-problems group, violence was associated with current substance use at levels below diagnostic criteria. Positive psychotic symptoms were linked to violence only in the group without conduct problems. Findings suggest that violence among adults with schizophrenia may follow at least two distinct pathways-one associated with premorbid conditions, including antisocial conduct, and another associated with the acute psychopathology of schizophrenia.     

National study comparing the characteristics of patients diagnosed with schizophrenia who committed homicide vs. those who died by suicide

Associations between serious mental disorder and violence are well-documented, but there is little epidemiological evidence linking these disorders and homicide risk. The reported study compares socio-demographic and clinical characteristics of people diagnosed with schizophrenia who committed homicide vs. those who died by suicide. The study is a national case series of male patients in England & Wales diagnosed with schizophrenia and convicted of homicide during 1997–2012 (n = 168), and a randomly selected comparison group of male patients with schizophrenia who died by suicide and who were matched to the homicide case series by age (n = 777). There are different patterns of behaviour in people with schizophrenia preceding homicide and suicide. Homicide perpetrators have frequently disengaged with services whilst patients who die by suicide are often in recent contact. This is important knowledge for clinical services as it indicates a different preventive emphasis despite the existence of other shared characteristics.     

Security in the Interparental Subsystem (SIS) Scale: Psychometric Characteristics in a Sample of Portuguese Adolescents

The Security in the Interparental Subsystem Scale (SIS) is based on emotional security theory. This study examined the psychometric properties of an adaptation of the SIS to a sample of Portuguese adolescents (60.3 % girls; 10 to 18 years old; Mage?=?13 years; N?=?229), recruited in public schools. Discriminant and concurrent validity were assessed by analyzing SIS dimensions associations with adolescents’ exposure to interparental conflict (IC), and psychological adjustment, respectively. Exploratory and confirmatory factor analyses of the SIS supported a six-factor solution, with satisfactory internal consistency. Evidence for discriminant and concurrent validity was provided: most SIS dimensions significantly discriminated between adolescents exposed to higher vs. lower levels of IC; and a significant positive association between emotional reactivity and adolescents’ externalizing symptoms was found. These findings suggest that the SIS is a reliable tool for assessing adolescents’ emotional insecurity in the interparental relationship within the context of this sample.     

ADHD symptomatology and its relationship with emotional,social and delinquency problems

Abstract

The main objective of the study was to investigate the relationship between symptoms of Attention Deficit Hyperactivity Disorder (ADHD) and a number of comorbid problems (i.e. poor socialization, anxiety, depression, and antisocial behaviour). Participants were clinical referrals for assessment of ADHD in adulthood and normal controls. ADHD adults were compared on measures of comorbid problems with: (a) individuals with mild psychiatric disorders (including attention problems) who were referred for an assessment of ADHD, but did not meet the criteria; and (b) a healthy control group. In addition, scores obtained on the comorbid measures were correlated with the YAQ-S and YAQ-I self- and parent-reported scales of ADHD Symptomatology, Emotional Problems, and Social Functioning. The ADHD group was more impaired than the normal controls on all the comorbid measures. Measures of socialization, anxiety, and antisocial behaviour differentiated them from normal controls and the clinical controls. There was a moderately high correlation between the YAQ-S and YAQ-I Delinquency Scale and the number of antisocial behaviours reported in the last year. Future research into ADHD, at least in adults, should include the investigation of potential importance of general adjustment problems rather than impulsivity per se and its relationship with offending.     

Treating impulsivity, irritability, and aggression of antisocial personality disorder with quetiapine

There are few effective treatments of antisocial personality disorder (APD). Preliminary work suggests that the atypical antipsychotic quetiapine can decrease irritability, impulsivity, and aggressiveness. Data were collected from 4 patients with APD who were referred to a maximum-security inpatient psychiatric facility for pretrial evaluation and were treated with quetiapine. Quetiapine was effective in these patients as was indicated by a decrease in symptoms such as impulsivity, hostility, aggressiveness, irritability, and rage reactions. Typical dosage was 600 to 800 mg per day. Patients attributed their willingness to comply with quetiapine treatment to both the effectiveness of the drug and its favorable adverse-event profile. Quetiapine was successfully combined with mood stabilizers, particularly gabapentin, in patients with prominent affective instability. Quetiapine has demonstrated efficacy in aggression, impulsivity, and irritability and has proved to be an effective medication in these patients with APD. In addition, its favorable adverse-event profile makes patients willing to comply.     

偏执型精神分裂症患者GRIN1基因-855G/C与-1140G/A位点的遗传多态性

目的探讨GRIN1基因启动子区两个单核苷酸多态性位点-855 G/C、-1140 G/A遗传多态性与偏执型精神分裂症的相关性及法医学意义。方法采用PCR限制性片段长度多态性(restriction fragment length polymorphism,RFLP)结合PAGE法对中国北方汉族183例健康无关个体和172例偏执型精神分裂症患者GRIN1基因5′端的-855 G/C和-1140 G/A位点多态性进行检测,采用χ2检验人群中基因型分布是否符合Hardy-Weinberg平衡定律,并比较两组人群中基因型和等位基因频率分布的差异。结果两组群体基因型分布符合Hardy-Weinberg平衡定律。-855 G/C位点基因型分布在对照组女性和实验组女性间的差异具有统计学意义(P0.05),-1140 G/A位点基因型和等位基因频率分布在对照组和实验组间及两组女性间差异具有统计学意义(P0.05)。结论 GRIN1基因启动子区-1140 G/A位点单核苷酸多态性可能与精神分裂症存在相关性;精神分裂症发生的遗传学因素可能存在性别倾向,可为精神分裂症的司法鉴定提供参考。     

精神分裂症患者的智力状况和刑事责任能力的关系

目的探讨在进行法医精神病学鉴定中精神分裂症患者的智力状况及刑事责任能力的关系。方法采用韦氏成人智力量表中国版(WAIS-RC)对138例精神分裂症患者进行测试,并与其相应的刑事责任能力进行Pearson相关分析。结果精神分裂症患者的全量表智商为±s=74.59±14.716;言语智商为±s=80.89±14.077;操作智商为±s=70.27±15.427。经统计分析发现:言语智商和操作智商(F=26.786,P=0.000)有显著性差异;各项智力结果与刑事责任能力相关性均不存在统计学意义(P>0.05)。结论精神分裂症患者平均智力水平在正常范围之下,边缘状态与轻度损害之间,但在法医精神病学鉴定中,其刑事责任能力与智力状况不存在相关性。     

Criminal Justice Contact,Stressors, and Depressive Symptoms Among Black Adults in the United States

Criminal justice contact—defined as lifetime arrest, parole, or incarceration is associated with higher odds of experiencing depressive symptoms. Findings from this study suggest that there is a mechanism that links family, neighborhood, and financial stressors among Black adults with criminal justice contact to depressive symptoms. Using the National Survey of American Life (NSAL), modified poisson regression analyses were used to determine the association between criminal justice contact, stressors, and depressive symptoms among a national sample of Black adults (n = 3570). In the full model, the odds of experiencing depressive symptoms for Black adults who had criminal justice contact was reduced (PR: 1.14 to PR: 1.07). Black adults who reported experiencing family stressors (PR: 1.10, 95% CI: 1.06, 1.16), neighborhood stressors (PR: 1.09, 95% CI: 1.04, 1.13), and financial stressors (PR: 1.13, 95% CI: 1.06, 1.19) were statistically significant and higher than those who reported not experiencing any of these stressors. Stressors partially mediates the relationship between criminal justice contact and depressive symptoms (OR: 1.05, Bias-corrected 95% CI: 1.04, 1.07); causing the effect of criminal justice contact to reduce to 1.06, leaving a significant indirect effect of 1.05. The total effect is 1.93 times larger than the direct effect, and 48.3% of the total effect is due to stressors. These findings emphasize the need to further explore the family, neighborhood, and financial stressors for Black adults with criminal justice contact in order to further our understanding of their depressive symptoms.