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.     

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.     

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。     

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.     

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.     

合并自杀的杀人行为研究(附40例分析)

目的　探索合并自杀的杀人行为的犯罪学特征、发生机理 ,为责任能力的评定提供依据 ,并提出进一步研究方向。　方法　采用回顾性研究方法 ,3名研究人员从 1997年 1月～ 2 0 0 1年 10月的鉴定案例中挑出符合研究条件的案例 ,进行统计学分析 ,并结合国内外相关文献进行讨论。　结果　符合条件者共 40例 ,男性被鉴定人较多 (2 8名 ) ,平均年龄 33.5 5岁 ,主要年龄段 30～ 40岁 ,妄想和情绪低落等症状具有明显的作用 ,精神分裂症和无精神病在疾病诊断中占有显著地位。　结论　合并自杀的杀人行为具有一定的特征 ,应引起司法精神病学的关注 ,并展开更深入的研究。     

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.     

合并自杀的杀人行为研究（附40例分析）

探索合并自杀的杀人行为的犯罪学特征、发生机理,为责任能力的评定提供依据,并提出进一步研究方向. 方法 采用回顾性研究方法 ,3名研究人员从1997年1月～2001年10月的鉴定案例中挑出符合研究条件的案例,进行统计学分析,并结合国内外相关文献进行讨论. 结果符合条件者共40例 ,男性被鉴定人较多(28名),平均年龄33.55岁,主要年龄段30～40岁,妄想和情绪低落等症状具有明显的作用,精神分裂症和无精神病在疾病诊断中占有显著地位. 结论 合并自杀的杀人行为具有一定的特征,应引起司法精神病学的关注,并展开更深入的研究.     

司法精神病学鉴定后的处理情况调查

目的 为了维护社会安全和依法保障精神病人的合法权益，需要正确处理精神病违法者。实际上，人们对司法精神病学鉴定后的处理情况知之甚少。因此，进行此项调查研究。方法 采用邮寄调查问卷的方式对四川省５２个县市的１８３例精神病违法者进行调查。结果 在处置精神病违法者的机关中，公安局占７３．０８％，法院占２６．７２％。有责任能力组中有２．２２％被无罪释放；无责任能力组中有２．１０％被判邢；部分责任能力组中有１     

司法精神病学鉴定后的处理情况调查

目的为了维护社会安全和依法保障精神病人的合法权益，需要正确处理精神病违法者。实际上，人们对司法精神病学鉴定后的处理情况知之甚少。因此，进行此项调查研究。方法采用邮寄调查问卷的方式对四川省52个县市的183例精神病违法者进行调查。结果在处置精神病违法者的机关中，公安局占73．08％，法院占26．72％。有责任能力组中有2．22％被无罪释放；无责任能力组中有2．10％被判刑；部分责任能力组中有13．95％被无罪释放。结论公安局是处理精神病违法者的主要机构。存在不适当处置情况，尤其对部分责任能力者的处理更复杂、更困难。     

Principles of the forensic psychiatric assessment of exhibitionism

Incompetence of the existing approach to forensic psychiatric assessment of exhibitionism as well as the necessity for conducting the analysis of direct manifestations of perverse behaviour are shown. Dissimilar clinical manifestations of this kind of paraphilias are presented and its fixed, compulsive and impulsive variants are described. The necessity for singling out differential forensic psychiatric criteria depending on psychopathologic characteristics of exhibitionism is stressed.