The profile of a major affective disorder offender

The authors review the studies on the relationship between crime and mental disorder conducted in various settings and point out that the incidence of major mental illnesses in general and of major affective disorders in particular, among the criminal population is relatively small. They present the profile of a major affective disorder offender presenting at a forensic psychiatric department of a university-based psychiatric hospital in a major Canadian city. This profile is based on the demographic, psychiatric, psychological and legal data on a sample of 46 consecutive patients with a diagnosis of major affective disorder. Even though the majority of these offenders are charged with relatively minor crimes and property offenses, they are often referred by the courts for in-patient assessment as many show active symptoms at the time of initial appearance in court. The ways the criminal justice system deals with these offenders are discussed. The benefits and limitations of describing a profile of any group of offenders are also considered.     

The prospectively observed course of illness among depressed patients who commit suicide

OBJECTIVE: These analyses were conducted to describe the course of illness among patients with major affective disorders who commit suicide. METHOD: Twenty-nine patients who entered a long-term, high-intensity follow-up study of major affective disorders and who later committed suicide within 1 year of their last follow-up interview were individually matched to other patients by age, sex, the presence or absence of lifetime drug or alcohol abuse, time to last interview and polarity. Those who suicided were compared with their controls by depressive and substance abuse morbidity during follow-up, treatment resistance, treatment compliance, suicidal behavior and psychosocial adjustment. RESULTS: Among the various measures used to characterize the course of illness during a mean follow-up of 4.3 years, only those pertaining to suicidal behavior robustly separated the suicide group from their controls. Suicidal behavior in the remote past seemed as predictively important as suicidal behavior during follow-up. CONCLUSION: Of the various features monitored over time in patients with major affective disorder, suicidal behavior itself was the clearest correlate of risk for completed suicide.     

Criminal Responsibility in Amphetamine Psychosis

Abstract: Historical changes in forensic psychiatric evaluation on criminal responsibility and proceedings in psychopathological findings of amphetamine psychosis are reviewed at first. The classification of amphetamine related mental disorders are proposed in 6 types. Among them, the clinical characteristics and psychopathological features of “Anxiety-situational reaction type” (Fukushima) are described. According to some reasonable grounds, offenders diagnosed as anxiety-situational reaction type should be evaluated as diminished responsibility in place of irresponsibility. Finally, two cases of murder committed under the influence of amphetamine, are reported in detail.     

Recidivism of the criminally insane in France: a 22-year follow-up

Characteristics of 1096 recidivistic mentally ill criminal offenders admitted to a specialized hospital in France are described. All subjects were mentally ill and had been judged nonresponsible for an act of crime. Crimes against persons (murder or assault) accounted for 42% of the crimes for which these patients were admitted. The remaining causes of admission were crimes against property (theft) and "victimless" crimes. Subject files indicated a wide difference in cause of admission for violent acts among the different diagnostic categories. Although the frequency of readmission and violent acts at readmission did not change for the group as a whole, they did change between admissions for the different diagnostic groups. Results indicate that differences exist between diagnostic categories of mentally ill offenders in terms of not only the type of crime committed but also the likelihood of recidivism.     

Criminal Responsibility in Amphetamine Psychosis

Abstract: Historical changes in forensic psychiatric evaluation on criminal responsibility and proceedings in psychopathological findings of amphetamine psychosis are reviewed at first. The classification of amphetamine related mental disorders are proposed in 6 types. Among them, the clinical characteristics and psychopathological features of "Anxiety-situational reaction type" (Fukushima) are described. According to some reasonable grounds, offenders diagnosed as anxiety-situational reaction type should be evaluated as diminished responsibility in place of irresponsibility. Finally, two cases of murder committed under the influence of amphetamine, are reported in detail.     

Mental disorder, intellectual deficiency, and crime. Evidence from a birth cohort.

Studies of criminality among patients in psychiatric hospitals and of mental disorder among incarcerated offenders have suggested an association between the major mental disorders (schizophrenia and major affective disorders) and crime. However, these investigations are characterized by notable methodological weaknesses, and, consequently, this conclusion has remained tentative. Little is known about the criminality of intellectually handicapped people. The present study examined the relationship between crime and mental disorder and crime and intellectual deficiency in an unselected Swedish birth cohort followed up to age 30 years. It was found that men with major mental disorders were 2 1/2 times more likely than men with no disorder or handicap to be registered for a criminal offense and four times more likely to be registered for a violent offense. Women with major disorders were five times more likely than women with no disorder or handicap to be registered for an offense and 27 times more likely to be registered for a violent offense. These subjects committed many serious offenses throughout their lives. The criminal behavior in over half these cases appeared before the age of 18 years. Intellectually handicapped men were three times more likely to offend than men with no disorder or handicap and five times more likely to commit a violent offense. Intellectually handicapped women were almost four times more likely to offend than women with no disorder or handicap and 25 times more likely to commit a violent offense.(ABSTRACT TRUNCATED AT 250 WORDS)     

Lithium and suicidal behavior in major affective disorder: a case-control study

OBJECTIVE: A number of studies have suggested that lithium may be particularly effective in reducing suicide risks among patients with major affective disorders. The design of many of these studies left them open to biases associated with treatment compliance, however. METHOD: Subjects were drawn from a naturalistic, long-term follow-up of patients with major affective disorders. Fifteen who committed suicide while receiving somatotherapy where matched to non-suicidal patients who were similarly receiving somatotherapy at the same point in follow-up. The same procedure was followed for 41 patients who made a serious suicide attempt during follow-up. RESULTS: Six (40.0%) of the patients who committed suicide, and eight (53.3%) of their controls, were thought to have been taking lithium in the preceding week. Among attempters and their controls, nine (22.0%) and eight (19.5%), respectively, were taking lithium. CONCLUSION: These results do not support previous suggestions that lithium has uniquely antisuicidal properties. Other existing datasets should be explored with this design to establish whether lithium does, or does not, offer special protection against suicide.     

Psychiatrische Erkrankungen und die Prognose krimineller Rückfälligkeit

The risk for criminal recidivism of mentally ill offenders is, unlike the general risk of delinquency, not well established. The relationship between psychiatric diagnosis and criminal recidivism was examined in the context of the Munich project on risk assessment. A total of 185 offenders had been examined on the question of culpability between 1992 and 1993. Re-offenses committed before the end of 2001 were recorded according to the Federal Registry of court sentences (Bundeszentralregister); 38.8% of the total group recidivated. High rates of recidivism were observed for individuals with substance abuse (45.5%) and with personality disorders (46.6%). The combination of the two illnesses increased the rate for recidivism to 50%. For individuals with organic, affective and neurotic disorders the rates for recidivism were below the average. Rates of recidivism for schizophrenic offenders were slightly higher, if re-offenses in the state of inculpability were included. The HCR-20 predicted recidivism equally well for offenders with and without a psychiatric diagnosis. In both groups, individuals with HCR-20 scores above the mean recidivated more often and after shorter periods of time.     

Relating psychiatric disorders, offender and offence characteristics in a sample of adolescent sex offenders and non-sex offenders

Introduction Several studies have paid attention to the relationship between psychiatric disorders and adolescent offending but few have distinguished different types of offenders, especially within the category of youngsters who have committed sex offences. Aim To test for relationships between psychiatric disorder and specific offence category among young male offenders. Method Nationwide data were extracted from Dutch Forensic Psychiatric Services (FPD) files for five groups of offenders, as defined by their index offence: 308 violent sex offenders; 134 non‐violent sex‐offenders; 270 sex offenders against children; 3148 violent offenders and 1620 offenders charged with any crime other than interpersonal body contact crimes. They were compared on individual characteristics and psychiatric diagnoses according to DSM‐IV criteria. Having a diagnosis of a paraphilia alone was exclusively associated with sex offending, therefore all such youths were excluded from further analyses. The OVERALS technique was used to explore possible relationships between offence, psychiatric diagnoses, sociodemographic and individual characteristics among the remaining young men for whom all pertinent data were available (n = 1894). Results Sex offenders constituted a distinct group of juvenile delinquents. Developmental disorders were more common among non‐violent sex offenders and child molesters. Violent offences were more typical of delinquents from immigrant backgrounds. Conclusion Group differences in types of psychiatric diagnoses may reflect differences in aetiological factors for the various types of sexual and other delinquent behaviour, and this would be worthy of further study. Copyright © 2007 John Wiley & Sons, Ltd.     

Characteristics of patients with major depression in combination with dysthymic or cyclothymic disorders. Childhood and precipitating events

The relationship between patients with acute major depression and chronic affective disorders was investigated in 298 nonpsychotic outpatients. The patients were categorized into 4 groups: major depression only, major depression with dysthymic or cyclothymic disorders, dysthymic or cyclothymic disorder without major depression and one group of other psychiatric disorders. The patients were interviewed about childhood losses, relationship to parents and siblings and family atmosphere, their personality characteristics as children, as well as precipitating events. The reports in the various diagnostic groups were compared. Patients in the mixed group reported somewhat more traumatic childhood experiences compared with patients in the pure major depression group and pure dysthymic-cyclothymic group, and much more traumatic childhood experiences compared with patients in the group of other disorders. Precipitating events among patients in the acute major depression group consisted of more acute external stressors compared with the events of the patients in the group of chronic affective disorders. Patients with major depression in combination with pure dysthymic-cyclothymic disorder generally remembered their childhood as having been more traumatic, with a less satisfying relationship to their parents.     

Psychiatric disorders in single and multiple sexual murderers

BACKGROUND: Sexual homicides - and particularly offenders with multiple victims - receive much attention in the general public as well as among forensic experts. The aim of this study was to assess psychiatric disorders in a large sample of sexual murderers and to identify disorders related to multiple sexual homicides. SAMPLING AND METHODS: Psychiatric court reports from 20 German forensic psychiatrists on 166 men who had committed a sexual homicide were evaluated for psychiatric disorders according to DSM-IV, including standardized instruments for personality disorders (criteria from the Structured Clinical Interview) and psychopathy (Psychopathy Checklist-Revised). Offenders with a single sexual homicide victim (n = 130) were compared to those with multiple victims (n = 36). RESULTS: High lifetime prevalence rates were found for substance abuse or dependence, paraphilias (especially sexual sadism), sexual dysfunctions and personality disorders (especially antisocial, borderline, sadistic and schizoid). In the multiple sexual murderer group sexual sadism, voyeurism, sadistic, antisocial and schizoid personality disorders were more frequent than in the single-victim group; none of the multiple offenders was diagnosed with a mood disorder. CONCLUSIONS AND LIMITATIONS: Multiple sexual murderers are characterized by disorders in three major psychopathological domains: sexual as well as 'character' sadism, antisociality and schizoid personality. A thorough diagnostic evaluation of Axis I as well as Axis II disorders should be part of risk assessments in sexual homicide perpetrators. Although the study was a retrospective investigation on psychiatric court reports, the size of the sample and consistency with results from previous studies give confidence that the identified group differences are unlikely to be due to methodological limitations.     

Relatives of unipolar and bipolar patients have normal pursuit

Impaired smooth pursuit eye movements are significantly less prevalent among the first-degree relatives of patients who have major affective disorders than among the first-degree relatives of schizophrenics. The distribution of normal and abnormal smooth pursuit among the relatives of unipolar and bipolar patients does not differ from that of normal individuals having no family history of major psychosis. Smooth pursuit impairment is thus specific to relatives of schizophrenic patients and is not characteristic of relatives of patients with major affective disorders.     

Factors associated with completed suicide in borderline personality disorder

Fifteen patients with a diagnosis of borderline personality disorder (BPD) who had committed suicide while under inpatient care or within a month after discharge were compared with a group of 13 inpatients with a diagnosis of BPD who did not kill themselves. Suicides occurred in all ages from 20 to 49 years. Age, sex, and age when first in contact with psychiatry did not differ between groups. DIB profiles differed only with respect to slightly higher scores on the affect section among patients who committed suicide. Axis I affective disorders were equally frequent. The patients who committed suicide had been more often hospitalized and they had made more suicide attempts in their lifetime. Male patients who killed themselves showed a more extensive suicidal behavior at admission than did their matched control subjects. Earlier suicide attempts during inpatient treatment were only identified among the patients who committed suicide. An imminent mandatory discharge preceded the inpatient suicides in five of 11 cases.     

The prediction of suicide. Sensitivity, specificity, and predictive value of a multivariate model applied to suicide among 1906 patients with affective disorders

Stepwise multiple logistic regression was utilized in an attempt to develop a statistical model that would predict suicide in a group of 1906 Iowans with affective disorders admitted to a tertiary care hospital. The risk factors identified by this approach included the number of prior suicide attempts, suicidal ideation on admission, bipolar affective disorder (manic or mixed type), gender, outcome at discharge, and unipolar depressive disorder in individuals with a family history of mania. However, the model failed to identify any of the patients who committed suicide. The results appear to support the contention that, based on present knowledge, it is not possible to predict suicide, even among a high-risk group of inpatients.     

The prevalence of mental disorders among offenders admitted at health facilities in Bizzah Makhate Correctional Service Centre,Kroonstand, South Africa

The aim of this study was to determine the prevalence of mental disorders among offenders admitted at the health establishments in Bizzah Makhathe Correctional Centre, South Africa. Structured psychiatric interviews were conducted to elicit the information. The majority of the participants were young male Africans with low educational levels and poor socio-economic status. Crimes against human beings were the most common ones committed by the offenders. The lifetime prevalence of mental disorders was 54.7%. Personality disorders, followed by substance and addictive disorders, were the most prominent disorders among the study sample. Other psychiatric disorders noted were depressive disorders, schizophrenia, intellectual disabilities and neurocognitive disorders. The results show that mental disorders in prisons go undetected and untreated, meaning that competency to stand trial and criminal responsibility are not always observed. There is a need to conduct more empirical studies on the prevalence and incidences of mental disorders in South African prisons.Key words: correctional service centres, crime, demographic information, health facilities, mental disorders, offenders, prevalence     

Affective disorder and homicide: a case of familial filicide theoretical and clinical considerations

This paper discusses a case of maternal homicide which occurred in the course of a major affective disorder. The relationship between mental illness and criminality is reviewed with a particular emphasis on affective disorder in relation to filicide. A number of significant issues are dealt with including consequences of failure to elicit positive family history of affective disorder, suicide and filicide. Indeed, a history of familial double filicide raises the question of possible hereditary influences. The significance of hypochondriacal symptomatology in the course of the illness and the role of steroids in precipitating or aggravating a psychotic depression also need to be explored. It primarily addresses the importance of prevention and recognition of risk factors associated with child murder committed by depressed parents.     

An outpatient psychiatry program for offenders with mental disorders found not guilty by reason of insanity

OBJECTIVE: Rehospitalization and criminal recidivism were examined among a group of offenders with mental disorders adjudicated as not guilty by reason of insanity and mandated to receive treatment in a forensic psychiatric outpatient program as a condition of release. METHODS: A retrospective chart review was conducted for 43 offenders with mental disorders who were acquitted as being not guilty by reason of insanity for the index offense and were active in the outpatient treatment program in 1996. Data were abstracted on sociodemographic, psychiatric, and criminal characteristics predating the index offense; rehospitalizations and new crimes and rearrests after the offense; and clinical and psychosocial functional outcomes after enrollment in the outpatient program. RESULTS: For the 43 patients, the mean length of stay in the program was 68 months, with a range of 4.9 months to 18.4 years. Almost two-thirds of the patients were diagnosed as having schizophrenia, schizoaffective disorder, or a nonaffective psychotic disorder; 58 percent had a comorbid substance use disorder, and 63 percent had an axis II diagnosis. Since program enrollment, 20 patients (47 percent) were rehospitalized at least once, and eight (19 percent) were rearrested or had committed a new crime. At the end of 1996, only nine (24 percent) were in full remission, and 26 (68 percent) showed at least one indicator of difficulty reintegrating into the community. CONCLUSIONS: Even after treatment in a specialized forensic program, this sample of offenders with serious mental disorders remained impaired symptomatically and functionally. Although avoidance of rehospitalization is considered a successful outcome, rehospitalization is preferable to rearrest for this forensic population.     

Impairments of attention and effort among patients with major affective disorders

Impairments of attention are common among people with major affective disorders, yet the influence of effortful task demands on attentional performance in unipolar and bipolar illness has been little studied. The authors compared psychiatric inpatients with primary diagnoses of unipolar or bipolar affective disorder (n=27) and age-matched normal control subjects (n=20) on a battery of eight neuropsychological tasks designed to measure different attentional functions. There were low-effort and high-effort versions of each task. Significant group differences were consistently observed on tasks demanding sustained and focused attention, but not on tasks requiring visual selective attention. Although affective disorder patients showed impairments on most tasks regardless of level of task effort, group differences were greatest on high-effort conditions. Results indicate that patients with major affective disorders show significant attentional impairments on most measures of effortful attention, and the magnitude of these impairments increases as the effortful demands of the task increase.     

Frequency of mental and addictive disorders among 320 men and women entering the Iowa prison system: use of the MINI-Plus

The Mini-International Neuropsychiatric Interview-Plus (MINI-Plus) was used to assess the frequency of mental and addictive disorders among 320 randomly selected men and women newly committed to the general population of the Iowa prison system. More than 90 percent of offenders met criteria for a current or lifetime psychiatric disorder. The most frequent were substance use disorders (90%), mood disorders (54%), psychotic disorders (35%), antisocial personality disorder (35%), and attention deficit hyperactivity disorder (22%). Offenders had a mean of 4.2 MINI-Plus disorders, and two-thirds had 3 or more disorders. Contrary to expectation, there were few gender-based differences. Thirty percent of the offenders were rated at risk for suicide. We conclude that mental and addictive disorders are common among incarcerated offenders and that these individuals are at risk for suicidal behavior.