Individuals with schizophrenia who act violently towards others profit unequally from inpatient treatment—Identifying subgroups by latent class analysis

BackgroundPeople with schizophrenia show a higher risk of committing violent offenses. Previous studies indicate that there are at least three subtypes of offenders with schizophrenia.ObjectivesEmploying latent class analysis, the goals of this study were to investigate the presence of homogeneous subgroups of offender patients in terms of remission in psychopathology during inpatient treatment and whether or not these are related to subtypes found in previous studies. Results should help identify patient subgroups benefitting insufficiently from forensic inpatient treatment and allow hypotheses on possibly more suitable therapy option for these patients.MethodsA series of latent class analyses was used to explore extensive and detailed psychopathological reports of 370 offender patients with schizophrenia before and after inpatient treatment.ResultsA framework developed by Hodgins to identify subgroups of offenders suffering from schizophrenia is useful in predicting remission of psychopathology over psychiatric inpatient treatment. While “early starters” were most likely to experience remission of psychopathology over treatment, “late late starters” and a subgroup including patients from all three of Hodgins'' subgroups in equal proportions benefited least. Negative symptoms generally seemed least likely to remit.ConclusionPsychiatric treatment may have to be more tailored to offender patient subgroups to allow them to benefit more equally.     

Characteristics of Child Maltreatment,Psychological Dissociation,and Somatoform Dissociation of Canadian Inmates

ABSTRACT

Data are presented on childhood maltreatment characteristics, psychological dissociation, somatoform dissociation, and offense types with a sample of 93 Canadian inmates (62 males and 31 females), with a mean age of 34 years (SD = 9.5). The present study includes findings based on the Child Maltreatment Interview Schedule-Short Form (CMIS-SF), the Detailed Assessment of Posttraumatic States (DAPS), the Multidimensional Dissociation Inventory (MDI), the Somatoform Dissociation Questionnaire (SDQ-20), and indices of violent and sexual offending during adulthood. Chi-square, Cohen's d, and regression analyses were conducted with the data. Results showed that women reported more childhood sexual abuse (CSA) than men, and men committed more violent and sexual offenses than women. Mean comparisons using Cohen's d statistic showed that inmates (N = 62) reported more trauma-related dissociation (DAPS) and more MDI dissociation compared to normative data for these instruments; however, inmates had lower somatoform dissociation scores when compared to published means of dissociative disorder, somatoform disorder, and eating-disorder patients. Inmates with CSA histories had higher SDQ-20 scores than those who did not. No differences were found between sex offenders and non-sex offenders in terms of probable PTSD, probable DID, MDI scales, or the SDQ-20. CSA that involved penetration predicted MDI dissociation and also predicted later sexual offending. Of the MDI scales, derealization and memory disturbance predicted sexual offending. Neither MDI scales nor any of the CMIS-SF maltreatment types predicted violent offending. Results are discussed in terms of treatment implications for incarcerated individuals with histories of child maltreatment.     

A Comparison of Sex Offenders and Other Types of Offenders Referred to Intellectual Disability Forensic Services

This study compared 131 sex offenders with ID and 346 other types of offenders with ID using case file records. All the females in the study were non sexual offenders. Significantly more sexual offenders were referred from court and criminal justice services while significantly fewer were referred from secondary healthcare. A higher percentage of sex offenders had some form of legal status at time of referral. Greater proportions of non sexual offenders were referred for aggression, damage to property, substance abuse and fire setting while only the sex offenders had an index sex offence. For previous offending, the non sexual offenders had higher rates of aggression, cruelty and neglect of children, property damage and substance abuse while the sexual offenders had higher rates of previous sexual offending. For psychiatric disturbance and adversity in childhood, only ADHD showed a significant difference between groups with the non sexual offenders recording higher rates.     

Reward Expectation Modulates the Identification of Facial Expressions of Emotion in Antisocial Offenders

This study assessed the expectation effects of monetary reward and monetary response cost on the performance of 57 offenders and 47 controls in a facial emotion identification task, applying a randomised cross-over design with three experimental conditions (monetary reward, monetary response cost and no-contingency). Offenders showed a poor performance compared with normal controls when the condition was monetary reward, but no differences between groups were found for the two other conditions. Within group analysis, offenders performed better when their response involved a monetary cost than a monetary reward. These results suggest that offenders may have a specific, reward-oriented motivational pattern, in which the expectation of having a monetary reward interferes negatively with the identification of facially expressed emotions, whereas the expectation of monetary cost does not seem to interfere with their performance. So, the performance of antisocial offenders in emotional identification tasks seems to be monetary condition specific.     

Establishing new breeds of (sex) offenders: science or political control?

Abstract

The British Government has recently announced their intention to criminalise the possession of “serious” sexually violent adult material and visits to web-sites depicting such scenes (despite their consensual and fantasy nature). Whilst clearly the prevention, banning and sanctioning of non-consenting sexual activities is essential, one wonders about the degree to which this proposed legislation is based on scientific findings, how far it will go, and whether this may become an oppressive approach to managing people's sexual fantasies that will do more harm than good.     

Resources for coping among women ex-offenders

Some women offenders cope well with community re-entry after serving judicial sentences, but little is known about the coping resources that help them succeed; research on women offenders most often examines causes of desistance from further criminality. The aim of this study was to illuminate the resources for coping used by ex-offenders who were deemed to be coping well in a community re-entry programme. Data in this qualitative study were collected from five in-depth interviews with women offenders in Norway, who were making good progression in a re-entry programme, and from one group interview with four professional staff working in two re-entry programmes. All respondents emphasized the importance to coping well of having some close relationships providing emotional and practical social support, having intrapersonal resources such as the ability to be self-reflective, staying sober, having employment or schooling opportunities, making plans for the future and using the re-entry services on offer.     

Sexuality changes in prostate cancer patients receiving antihormonal therapy combining the antiandrogen flutamide with medical (LHRH agonist) or surgical castration

The results of a written questionnaire with 44 patients (pilot study) indicated that before the beginning of treatment for advanced prostatic cancer, most subjects had an active sexual life, as illustrated by a normal erotic imagery, an adequate sexual desire and a normal frequency of intercourse. More than three-quarters (80%) of subjects had at least one coitus a week. Slightly more than 50% were able to easily achieve an erection by erotic imagery or by a preferred sexual fantasy; 50% never experienced erectile problems. When compared with their previous sexual functioning, 70% of subjects noticed during the antiandrogenic treatment a major reduction in their interest for sexual intercourse which was maintained in only 18% of patients. It became impossible for 57% to induce an erection by erotic imagery. However, 19% claimed an ability to maintain an erection during sexual activity, as compared to 56% before treatment, but erections usually lacked full rigidity. Twenty-two percent of patients mentioned having nocturnal or morning erections. Despite this dramatic decrease in sexual activity in most patients, complete antiandrogen blockade left sexual activity in approximately 20% of patients. Due to the treatment's excellent tolerance, the findings suggest that such combined androgen blockade could be beneficial for the treatment of sex offenders.A preliminary report of this work was presented at the International Symposium on LHRH and its Analogues held in Québec City on June 28–30th, 1984.     

Should Actuarial Risk Assessments be Used with Sex Offenders who are Intellectually Disabled?

Background Objective actuarial assessments are critical for making risk decisions, determining the necessary level of supervision and intensity of treatment ( Andrews & Bonta 2003 ). This paper reviews the history of organized risk assessment and discusses some issues in current attitudes towards sexual offenders with intellectual disabilities. Method We present two risk assessment tools (RRASOR and STABLE‐2000) that appear to have practical utility with this population. Data are presented from a community sample of 81 sexual offenders who are intellectually disabled suggesting that the RRASOR may provide a useful metric of risk for this population. Dynamic risk is assessed using the STABLE‐2000. This tool, based on 16 areas empirically associated with sexual recidivism, samples the individuals’ current behaviour, skill deficits and personality factors. Change in these factors serves to flag the supervisor to changing risk levels. Conclusions In addressing the question of whether we should seek special risk measures normed on people with intellectually disabilities, given the current lack of alternative tools, we conclude that it is reasonable to make use of the risk assessments that have been validated on the general sex offender population.