The dynamic prediction of antisocial behavior among forensic psychiatric patients: a prospective field study

Staff ratings of 595 supervised forensic psychiatric patients on the Proximal Risk Factor Scale and the Problem Identification Checklist were completed monthly for an average of 33 months. During the follow-up, there were 265 incidents, 86 of which were violent. The average ratings, excluding those from the index month, differentiated patients who had incidents from those who did not. As well, the average ratings distinguished between individuals with and without incidents of a violent or sexual nature. There were significant increases in staff ratings in the months preceding the index incident month. Within-patient analyses showed that changes in dynamic risk scales comprising the best items for predicting incidents of any kind and violent or sexual incidents were strongly related to their respective outcomes and were significantly related to outcome in an independent sample. Changes in monthly staff ratings predict the imminent occurrence of antisocial and violent behaviors.     

Risk of homicidal behaviour among persons convicted of homicide

We studied the risk of homicidal behaviour among persons convicted of homicide using an epidemiological method. The results showed that male homicide offenders are at least 10 times more likely to commit a homicide when compared with general male population. This odds ratio was about 150-fold among offenders who had committed at least four previous aggravated violent crimes as well as homicide.     

PCL-R psychopathy predicts disruptive behavior among male offenders in a Dutch forensic psychiatric hospital

In this study, the relationship between psychopathy, according to the Dutch language version of Hare's Psychopathy Checklist-Revised (PCL-R), and various types of disruptive behavior during inpatient forensic psychiatric treatment is investigated. Ninety-two male participants were administered the PCL-R following admission to an inpatient forensic hospital. From daily hospital information bulletins, incidents of verbal abuse, verbal threat, physical violence, and violation of hospital rules were derived. Also, the number of seclusion episodes was recorded. As expected, significant correlations were found between PCL-R scores and verbal abuse, verbal threat, violation of rules, total number of incidents, and frequency of seclusion. Psychopaths (PCL-R > or = 30) were significantly more often involved in incidents than nonpsychopaths. Multiple regression analyses revealed that the PCL-R Factor 2 score in particular contributed uniquely to the prediction of the total number of incidents. The findings are discussed in terms of their clinical implications.     

精神病人的凶杀行为研究(附116例分析)

目的　探讨凶杀行为的特征及相关因素。　方法　采用回顾性研究方法 ,对 116例凶杀案例资料进行统计分析。　结果　凶杀行为与患者的性别、年龄、社会经济状况、疾病诊断、精神症状等因素关系密切 ,案发前多有先兆。　结论　加强精神卫生知识的宣传教育和精神卫生立法是预防精神病人肇事、肇祸的有效途径。     

Assaultive behavior in state psychiatric hospitals: differences between forensic and nonforensic patients

Forensic patients are occupying an increasingly large number of beds in state psychiatric hospitals. The presence of these mentally ill offenders has raised concerns about the risk they present to nonforensic patients. This study compared the rate of assaults and factors associated with assaultive behavior among 308 nonforensic patients and two groups of forensic patients including 469 patients found not guilty by reason of insanity and 76 pretrial patients. Consistent with other studies, nonforensic patients had higher rates of assaults than either group of forensic patients. However, being a forensic patient did not affect the odds of assault when controlling for the effects of demographic and clinical variables in a multivariate logistic regression analysis. Factors associated with assaults in each of the three patient groups were identified using multivariate analyses. Implications are presented for treatment of assaultive behavior, mixing of forensic and nonforensic patients within state hospitals, forensic release policies, and future research.     

精神病人的凶杀行为研究(附116例分析)

目的 探讨凶杀行为的特征及相关因素。方法 采用回顾性研究方法，对116例凶杀案例资料进行统计分析。结果 凶杀行为与患者的性别、年龄、社会经济状况、疾病诊断、精神症状等因素关系密切，案发前多有先兆。结论 加强精神卫生知识的宣传教育和精神卫生立法是预防精神病人肇事、肇祸的有效途径。     

Deceptive behaviour and instrumental violence among psychopathic and non-psychopathic violent forensic psychiatric patients

Deceptive behaviour and instrumental violence are well-known psychopathic features and as such play important roles in the assessment of psychopathy. This study examined first, the nature of the violence committed by offenders that have been admitted to forensic psychiatric care and whether scores on the Psychopathy Checklist: Screening Version (PCL:SV), Part 1, were associated with the instrumentality of violence. Second, we examined the proneness of offenders to re-frame the instrumentality in their past violent crimes, and whether this was associated with scores on the PCL:SV. The results show that the PCL:SV, Part 1 (interpersonal/affective features), was positively related to the officially coded instrumentality of the violent crimes. As expected, this association disappeared when the instrumentality was self-reported. However, the majority of the patients tended to exaggerate the reactivity of their violent crimes when it was self-reported, indicating that most offenders, independently of level of psychopathy, used deception when questioned about the characteristics of their past violent crimes. The reasons for, and implications of, the use of deception are discussed.     

Substance use disorders in forensic psychiatric patients

There is a lack of detailed information on the role of substance use disorders (SUD) as a substantial factor in offences and treatment in forensic psychiatric patients. The aim of this study was to get a better understanding of these specifics. Clinical records of 193 male patients admitted to a Dutch forensic psychiatric hospital were scrutinized on anamnestic, diagnostic and risk assessment data. One of the central findings was that the prevalence of SUDs was high. Patients with an SUD had a more extensive criminal history, unstable and deviant lifestyle and higher risk of violent behavior than patients without a substance use disorder. No differences were found in duration of treatment, aggressive incidents and leave. Another important finding was that a distinction could be made between patients with substance use as a primary criminogenic risk factor and patients with substance use as a secondary risk factor. Although substance use is identified as a general risk factor, this study supports the idea of sub categorization of patients with an SUD and emphasizes the need for a different treatment approach. Further study is needed to identify specific treatment approaches, based on more differentiated profiles of these patients.     

Reading level and the prevalence of a dyslexic profile among patients in a forensic psychiatric clinic

This study aims to investigate Swedish language reading ability of forensic patients and the number of them that present a dyslexia profile. Another aim is to compare the reading level in different subtypes of psychiatric diagnoses. Assessments were made of 185 patients by a battery of reading tests. They were also interviewed about their schooling and their self-estimated reading and writing ability. The results show that the patients’ reading level is below average for grade six children in Swedish compulsory school, and that 16 per cent show a dyslexic profile. Male patients with an immigrant background and a diagnosis of psychosis and anxiety disorders perform the lowest when measuring literacy skills. This proportionately low reading ability can cause difficulties in understanding texts as presented in broadsheet newspapers, civic information and patient records, and might even jeopardize the understanding of adult spoken language.     

The impact of forced forensic psychiatric confinement on composition and structure in the personal networks of personality-disordered forensic psychiatric patients

This study explored to what extent the composition and structure of personal networks of personality-disordered forensic psychiatric patients changed before and after forced confinement in a forensic psychiatric centre. Semi-structured in-depth interviews with 36 patients and selected members of their networks were examined. During forensic psychiatric treatment, patients reported a decrease in network size, in the number of high-risk network members, and in the number of social ties between these high-risk network members. Personal relationships were of shorter duration, with lower levels of contact frequency and reciprocity. No changes were observed in the patients’ companionship, practical and emotional support networks. During forensic psychiatric treatment, patients reported some new relationships, especially with persons outside the forensic psychiatric centre. Information on compositional and structural personal network factors over time helps forensic mental health professionals to properly assess and manage the important dynamic social network conditions associated with recidivism.     

The forensic psychiatric evaluation of mental disorders in diabetic patients

The article deals with the results of investigation of psychic disturbances in 7 patients with diabetes mellitus. Psychic dysfunctions which are important for forensic psychiatric practice (depressions, transitory psychotic episodes at the background of hyperglycemia and pathologic states with consciousness disturbance, psychomotor excitement and incorrect behaviour in hypoglycemic states) were analysed. Characteristics were noted which contributed to diagnosing in patients with diabetes mellitus, the states of temporary morbid mental disorder and choosing correct expert conclusion in relation to persons who committed indictable actions.     

Domestically and generally violent forensic psychiatric outpatients: personality traits and behavior

A group of 63 domestically violent patients and a group of 103 generally violent patients at a Dutch forensic psychiatric outpatient clinic are examined with regard to personality traits and problem behaviors to develop treatment programs for domestically violent patients. The domestically violent patients are more unstable from a psychological viewpoint but not more inclined to anger than the average Dutch male. They report less anxiety in situations in which criticism can be given but more anxiety in situations in which someone can be given a compliment. When comparing domestically violent patients with generally violent patients, domestically violent patients score lower on anger as disposition and on aggressive behavior than the generally violent patients do. However, both groups do not differ from each other in their score on the dimension of psychopathy.     

Psychological assessment of forensic psychiatric outpatients

The 1960s decrease in long-term residential mental health care resulted in former psychiatric patients being admitted to correctional and forensic psychiatric facilities. Although psychologists face challenges in managing and treating this displaced population, assessment data plays a pivotal role in the determination of appropriate aftercare for the mentally ill parolee. This article discusses the assessment protocol utilized by the Forensic Conditional Release Program (CONREP) in California, summarizes data from these patients, and uses case excerpts to illustrate the potential value of assessment with a forensic psychiatric (outpatient) population. Special emphasis is given to the use of the MMPI-2 and Rorschach.     

Language disorders in disruptive behavior disordered homicidal youth.

Eight homicidal youths were assessed for language disorders and psychiatric diagnoses using a battery of standardized language tests and the Diagnostic Interview for Children and Adolescents. Both language disorders and Diagnostic and Statistical Manual III-R psychiatric diagnoses were present in all subjects.     

Characteristics of female patients admitted to an adolescent secure forensic psychiatric hospital

Bluebird House is the only mixed gender NHS secure forensic psychiatric hospital for adolescents in the South of England. It has admitted more than 30 female patients since the service opened in 2008. The admission criteria are that patients must be detained under the Mental Health Act and present evidence of being a risk of harm to others. This article describes the clinical characteristics of 30 consecutive female patients admitted to a highly specialised adolescent forensic inpatient service. Key results include a very high rate of incidents of risk behaviours exhibited by female patients within the unit but good clinical outcomes. The majority of patients had severe symptoms of mental disorder, especially emotional instability, self-harm behaviours and aggressive behaviours. Few had diagnoses of mental illness. Assessment findings from the Millon Adolescent Clinical Inventory and the Structured Assessment of Violence Risk are discussed, as are parallel with studies from other female secure services.