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Findeis H, Strauß M, Kröber HL. The TCO concept in German forensic homicide offenders with schizophrenia spectrum disorders - new findings from a file-based, retrospective cross-sectional study. Front Psychiatry 2024; 15:1404263. [PMID: 38919633 PMCID: PMC11196989 DOI: 10.3389/fpsyt.2024.1404263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/22/2024] [Indexed: 06/27/2024] Open
Abstract
Introduction There is evidence that there is a small group of people with schizophrenia spectrum disorders who are more likely to commit homicide than those in the general population. However, there is limited knowledge about the psychopathology that leads to homicide in this group. The aim of this study was to examine two commonly used definitions of the Threat/Control-Override (TCO) concept, which aims to identify a certain risk of serious violence in patients with schizophrenia spectrum disorders. Methods This is a sub analysis of a file-based, retrospective and exploratory cross-sectional study. All forensic homicide offenders with schizophrenia spectrum disorders who were detained at the Forensic Hospital Berlin as of 31 December 2014 were examined for the occurrence of TCO according to two commonly used definitions. Results Of a total of 419 forensic patients with schizophrenia spectrum disorders, 78 committed homicide (18.6%). The forensic homicide offenders with schizophrenia spectrum disorders were characterised by being male, unemployed, single and having committed (attempted) manslaughter. Irrespective of the definition used, the entire TCO complex was present in less than a third of the sample. In both definitions, Threat symptoms were slightly less frequent than Control-Override symptoms. While Threat symptoms occurred less frequently in Stompe et al.'s definition, Control-Override symptoms were the most common. With regard to Kröber's definition of Threat and Control-Override, the situation is exactly the opposite. Discussion Regarding the entire TCO complex, Kröber's definition seems a little more open and Stompe et al.'s more strict (38.5% vs. 35.9%). Since TCO only occurs in about one third of the subjects in both definitions, neither definition appears to be conclusive. A combination with proportions from both definitions could be a contribution to a future definition of TCO. The present study provides scarcely published primary data on psychopathology in homicide offenders with schizophrenia spectrum disorders, especially on the much discussed TCO concept in two definitions. In order to determine the most useful definition of TCO, to avoid false positives and to identify clear psychopathological risk symptoms, larger samples and comparative studies with offenders and non-offenders should be conducted in the future.
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Affiliation(s)
- Hannelore Findeis
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig, Leipzig, Germany
- Institut für Forensische Psychiatrie, Charité Berlin, Berlin, Germany
| | - Maria Strauß
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig, Leipzig, Germany
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Carabellese F, Mandarelli G, Felthous AR, Catanesi R. Forensic psychiatric evaluation of 187 homicidal assailants with and without a schizophrenia spectrum disorder: Clinical, criminological and behavioral characteristics. BEHAVIORAL SCIENCES & THE LAW 2021; 39:190-204. [PMID: 34037268 DOI: 10.1002/bsl.2515] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/24/2021] [Accepted: 02/02/2021] [Indexed: 06/12/2023]
Abstract
Intentional homicide, a declining phenomenon in Italy, represents one of the most extreme forms of violence. A specific subgroup of homicidal assailants is represented by those affected by mental disorders, where the relationship between psychopathology and characteristics of the homicidal attack is not yet fully understood. We analyzed the case files of 187 homicides or attempted homicides, in which the defendant had undergone a forensic psychiatric evaluation within the previous 10 years from a single forensic psychiatric center. We described and analyzed the perpetrator, victim and criminological characteristics of the study cases. A diagnosis of a schizophrenia spectrum disorder, a victim who was the perpetrator's biological child and absence of a personality disorder diagnosis were associated with an increased probability of having been adjudicated as lacking or having substantially diminished criminal responsibility due to a mental disorder. Homicidal assailants with a schizophrenia spectrum disorder showed some differences in criminological characteristics compared with murderers without a schizophrenic spectrum disorder, including a higher incidence of parricide, interruption of pharmacotherapy before the crime and disorganized post-crime behavior.
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Affiliation(s)
- Felice Carabellese
- Section of Criminology and Forensic Psychiatry, Department of Internal Medicine, University of Bari Aldo Moro, Policlinico Universitario, Bari, Italy
| | - Gabriele Mandarelli
- Section of Criminology and Forensic Psychiatry, Department of Internal Medicine, University of Bari Aldo Moro, Policlinico Universitario, Bari, Italy
| | - Alan R Felthous
- Forensic Psychiatry Division, Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Roberto Catanesi
- Section of Criminology and Forensic Psychiatry, Department of Internal Medicine, University of Bari Aldo Moro, Policlinico Universitario, Bari, Italy
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Hachtel H, Nixon M, Bennett D, Mullen P, Ogloff J. Motives, Offending Behavior, and Gender Differences in Murder Perpetrators With or Without Psychosis. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:3168-3190. [PMID: 29759034 DOI: 10.1177/0886260518774304] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Little is known whether differences exist in motivation and reactive/instrumental offense behaviors between murder offenders with and without psychotic disorder. To contribute to better prevention strategies, the aim of this study was to investigate offense characteristics in murder offenders with a psychotic, nonpsychotic or no psychiatric diagnosis, and whether these factors differ according to sex. This data study examined the population of murder offenders between 1997 and 2005 (N = 435) in Victoria, Australia. Apparent motive for murder was allocated to one of six classifications. Assignations of reactive versus instrumental offense categories, co-offending, victim-offender relationship were determined by review of case material. Mental health service usage and prevalence of mental illnesses were identified through data with the statewide register of contacts with the public mental health system. Of the 435 offenders, 43 (9.9%) had been diagnosed with a psychotic illness. Gender differences between and within offenders with and without a psychotic disorder were analyzed. Murder offenders with a psychotic disorder were 3.19 (95% confidence interval [CI] = [1.27, 8.03]) times more likely to be motivated by revenge than nonpsychotic offenders and those with no diagnosis (odds ratio [OR] = 2.46, 95% CI = [1.10, 5.53]). The diagnostic groups did not differ on premeditation of their offenses or prior convictions. Perpetrators with psychotic illness were significantly more likely to kill family members and others known to them. It appears that for the psychotic disorder group, the perception of having been wronged in some way is a potential risk marker for planning and committing a serious offense. Care should be taken to improve adherence and access to care to avoid possible future serious violence especially in female patients with a high burden of mental illness like schizophrenia or severe mood disorders.
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Affiliation(s)
- Henning Hachtel
- Swinburne University of Technology, Clifton Hill, Victoria, Australia
- University of Basel, Basel, Switzerland
| | - Margaret Nixon
- Swinburne University of Technology, Clifton Hill, Victoria, Australia
| | | | - Paul Mullen
- Monash University, Clayton, Victoria, Australia
| | - James Ogloff
- Swinburne University of Technology, Clifton Hill, Victoria, Australia
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Pathways to aggression and violence in psychosis without longstanding antisocial behavior: A review and proposed psychosocial model for integrative clinical interventions. Psychiatry Res 2020; 293:113427. [PMID: 32866792 DOI: 10.1016/j.psychres.2020.113427] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/19/2020] [Accepted: 08/23/2020] [Indexed: 11/22/2022]
Abstract
There is a need for a clearer understanding of the factors associated with increased risk of aggression and violence (AV) among people with psychosis and other severe mental illness (SMI) to guide effective prevention and intervention. The current article (1) reviews the literature regarding psychosocial factors associated with AV among individuals with psychosis and other SMI who do not have longstanding antisocial behaviors, (2) proposes an integrative psychosocial model of AV that can be practically applied, and (3) proposes appropriate evidence-based clinical interventions to reduce AV and facilitate recovery. We propose that increased risk for AV among people with psychosis is driven by anger, which is affected by a range of factors including victimization and situational stressors, social rejection or experiences of discrimination, anxious arousal, and hostile attribution bias related to psychosis. The cumulative effect of these systems is exacerbated by co-occurring substance misuse and increased impulsivity, particularly negative urgency. In consideration of the current psychosocial model and existing evidence-based interventions for AV in individuals with psychosis, we propose that trauma-informed interventions that integrate skills training in emotion regulation, social and interpersonal situations, cognitive restructuring and remediation, and modified prolonged exposure may demonstrate the most promise for this population.
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Groleau R, Da Silva Guerreiro J. Agression en milieu psychiatrique fermé : identification des déclencheurs qui précèdent les agressions contre les intervenants. ACTA ACUST UNITED AC 2019. [DOI: 10.7202/1060006ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cette étude vise l’identification des déclencheurs qui précèdent les agressions survenues dans un hôpital psychiatrique fermé. Une analyse de contenu de 140 rapports d’incident visant l’identification du déclencheur qui précédait immédiatement les événements d’agression survenus entre 2012 et 2017 a été effectuée. Avec un accord interjuge de 0,87, les résultats concordent avec ceux retrouvés dans des études précédentes. Plus de 37 % des agressions surviennent à la suite d’une intervention verbale d’un intervenant, alors qu’un peu plus de 54 % ont lieu à la suite d’un contact physique entre un intervenant et un patient. Moins de 9 % des agressions subies par le personnel sont liées à des événements où il a été impossible d’observer un déclencheur. Ces résultats sont discutés dans le cadre d’une approche interactionnelle sur l’agression en psychiatrie légale et ils permettent de proposer des pistes pour réduire le risque d’agression.
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Affiliation(s)
- Robert Groleau
- Institut national de psychiatrie légale Philippe-Pinel. Correspondance : Institut national de psychiatrie légale Philippe-Pinel, Direction des soins infirmiers et des services multidisciplinaires, 10905 Henri-Bourassa Est, Montréal (Québec), H1C 1H1
| | - Joao Da Silva Guerreiro
- Département de psychologie, Université du Québec à Montréal
- Centre de recherche de l’Institut national de psychiatrie légale Philippe-Pinel
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Cheng SY, Chen WY, Liu HC, Yang TW, Pan CH, Yang SY, Kuo CJ. Benzodiazepines and risk of pneumonia in schizophrenia: a nationwide case-control study. Psychopharmacology (Berl) 2018; 235:3329-3338. [PMID: 30232530 DOI: 10.1007/s00213-018-5039-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 09/14/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To investigate the relationship between benzodiazepine and risk of developing pneumonia in patients with schizophrenia, whose benzodiazepine dosage and usage frequency was higher than that of the general population. METHODS We conducted a nested case-control study to assess the association between benzodiazepine use and pneumonia among patients with schizophrenia. By using the Taiwan National Health Insurance Research Database, we identified a schizophrenia cohort comprising 34,929 patients during 2000-2010. Within the schizophrenia cohort, 2501 cases of pneumonia and 9961 matched control patients (1:4 ratio) were identified. Benzodiazepine exposure was categorized by drug, treatment duration, and daily dose. Conditional logistic regression models were used to examine the association between benzodiazepine exposure and the risk of pneumonia. RESULTS The current use (within 30 days) of midazolam led to the highest pneumonia risk (adjusted risk ratio = 6.56, P < 0.001), followed by diazepam (3.43, P < 0.001), lorazepam (2.16, P < 0.001), and triazolam (1.80, P = 0.019). Furthermore, nearly all the benzodiazepines under current use had a dose-dependent effect on pneumonia risk. The risk of pneumonia was correlated with the affinities of γ-aminobutyric acid A α1, α2, and α3 receptors. CONCLUSIONS Benzodiazepines had a dose-dependent relationship with pneumonia in patients with schizophrenia. The differences in risk and mechanism of action of the individual drugs require further investigation. Clinicians should be aware of the early signs of pneumonia in patients with schizophrenia receiving benzodiazepines.
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Affiliation(s)
- Sheng-Yun Cheng
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Wen-Yin Chen
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.,Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Hsing-Cheng Liu
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Tien-Wei Yang
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chun-Hung Pan
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.,Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Shu-Yu Yang
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chian-Jue Kuo
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan. .,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. .,Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan. .,Department of General Psychiatry, Taipei City Psychiatric Center, 309 Sung-Te Road, Taipei, 110, Taiwan.
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7
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Weatherly JN. The Association Between Delay Discounting and Schizotypal Personality Characteristics in a Nonclinical Sample. PSYCHOLOGICAL RECORD 2017. [DOI: 10.1007/bf03395818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bilgi MM, Taspinar S, Aksoy B, Oguz K, Coburn K, Gonul AS. The relationship between childhood trauma, emotion recognition, and irritability in schizophrenia patients. Psychiatry Res 2017; 251:90-96. [PMID: 28192770 DOI: 10.1016/j.psychres.2017.01.091] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 11/27/2022]
Abstract
This study investigated the relationship between childhood trauma, irritability, and emotion recognition, in schizophrenia patients during a psychotic break. Thirty-six schizophrenia inpatients and 36 healthy controls were assessed with the Irritability Questionnaire (IRQ) and two facial emotion recognition tasks, the Emotion Discrimination Test (EDT) and Emotion Identification Test (EIT). Patients were further assessed with the Structured Clinical Interview for DSM III-R Axis II Disorders (SCID-II), the Positive and Negative Symptom Scale (PANSS), and the Childhood Trauma Questionnaire-28 (CTQ-28). EDT and EIT performance was significantly impaired in patients compared to healthy controls. Furthermore, patients tended to misidentify sad, surprised, or angry faces as showing fear, and this misidentification correlated with the patients' irritability. Childhood adversity increased irritability both directly and indirectly through emotion misidentification.
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Affiliation(s)
- Mustafa Melih Bilgi
- SoCAT Neuroscience Research Group, Izmir Bozyaka Research and Education Hospital, Karabaglar State Clinics, 4025 Sok., Yunus Emre Mah., Karabaglar, Izmir, Turkey.
| | - Seval Taspinar
- SoCAT Neuroscience Research Group, Siirt State Hospital, Yenimahalle Gures Cad. Siirt, Turkey.
| | - Burcu Aksoy
- SoCAT Neuroscience Research Group, Dokuz Eylul University, School of Nursing, Izmir, Turkey.
| | - Kaya Oguz
- SoCAT Neuroscience Research Group, Ege University, International Computer Institute, Information Technologies, Izmir, Turkey.
| | - Kerry Coburn
- Mercer University Department of Psychiatry and Behavioral Science, 655 First Street Macon, GA, USA.
| | - Ali Saffet Gonul
- Mercer University Department of Psychiatry and Behavioral Science, 655 First Street Macon, GA, USA; SoCAT Neuroscience Research Group, Ege School of Medicine, Department of Psychiatry, Turkey.
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Merced M. How Narcissistic Injury May Contribute to Reactive Violence: A Case Example Using Stanley Kubrick's The Shining. INTERNATIONAL JOURNAL OF APPLIED PSYCHOANALYTIC STUDIES 2017. [DOI: 10.1002/aps.1484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Matthew Merced
- Independent Practice; 78115 Calle Estado, Suite 201 La Quinta CA 92253 USA
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Guivarch J, Piercecchi-Marti MD, Glezer D, Murdymootoo V, Chabannes JM, Poinso F. Is the French criminal psychiatric assessment in crisis? INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2017; 51:33-41. [PMID: 28242031 DOI: 10.1016/j.ijlp.2017.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 11/01/2016] [Accepted: 01/18/2017] [Indexed: 06/06/2023]
Abstract
The criminal psychiatric assessment in France seems to be facing growing criticism related to disagreements between experts and, on the other hand, a lack of interest of psychiatrists for the assessment. We start by explaining the current framework of the criminal psychiatric assessment in France, which differs from the assessment used in English-speaking countries, where Roman law applies. Then, we will describe the disagreements through a literature review and two clinical vignettes. Finally, we will try to understand the causes of discrepancies between experts and the reasons for a supposed lack of interest of the psychiatrists for the expertise. For this, we conducted a survey among the psychiatric experts. We individually questioned experts on the discrepancies and on their awareness of the expertise. We found that 75% of the experts we surveyed had already faced the divergent opinion of a colleague. In addition, the experts were divided on their conclusions related to the fictional scenario we gave them for an a priori assessment (a person with schizophrenia who was accused of murder), particularly in the specific contexts that we submitted to them. The main cause of disagreement between experts was the various schools of thought that influence the psychiatric experts in the forensic discussion and, therefore, the conclusions of a case. Moreover, the experts believed that the decrease in the number of psychiatric experts could be attributed to the adverse financial situation of the assessment, the considerable workload required, and the extensive responsibility that falls on the expert. Calling on a team of forensic experts to perform assessments seems to be the first solution to this crisis. Furthermore, if the experts were better compensated for the assessments, more people would want to undertake this work.
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Affiliation(s)
- J Guivarch
- Service de Pédopsychiatrie, CHU Sainte Marguerite, 270 Boulevard de Sainte Marguerite, 13274 Marseille Cedex 9, France; Institut des Sciences Criminelles, Poitiers, France.
| | - M-D Piercecchi-Marti
- Service de Médecine Légale et Droit de la Santé, CHU Timone, 13385 Marseille Cedex 5, France; CNRS, EFS, ADES UMR 7268, Aix Marseille Université, 13916 Marseille, France
| | - D Glezer
- CRIR AVS PACA, CHU Sainte Marguerite, 270 Boulevard Sainte Marguerite, 13274 Marseille Cedex 9, France
| | - V Murdymootoo
- Service de Pédopsychiatrie, CHU Sainte Marguerite, 270 Boulevard de Sainte Marguerite, 13274 Marseille Cedex 9, France
| | - J-M Chabannes
- Service de Psychiatrie Adulte, CHU Conception, 147 Boulevard Baille, 13385 Marseille Cedex 5, France
| | - F Poinso
- Service de Pédopsychiatrie, CHU Sainte Marguerite, 270 Boulevard de Sainte Marguerite, 13274 Marseille Cedex 9, France
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Guivarch J, Piercecchi-Marti MD, Glezer D, Chabannes JM. [Differences in psychiatric expertise of responsibility for schizophrenic persons accused of murder: Study with experts of the Court of Appeal of Aix-en-Provence]. Encephale 2015; 42:296-303. [PMID: 26471517 DOI: 10.1016/j.encep.2015.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 01/09/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION In France, forensic psychiatric assessment plays a central role in the relationship between psychiatry and justice. The psychiatric expert is commissioned to determine whether or not the accused has a mental disorder and to specify whether or not it affected discernment at the time of offense. Nowadays, psychiatric expertise is coming under more and more criticism, particularly regarding divergences between experts. OBJECTIVES Our objectives were to find points of divergence between experts, try to understand causes and suggest ways to try to reduce them. METHODS For this we conducted a study, between July 2012 and January 2013, with psychiatric experts of the Court of Appeal of Aix-en-Provence through semi-structured interviews. We focused on a limited context: psychiatric expertise of responsibility for schizophrenic persons accused of murder. We questioned the experts about the issue of criminal liability of a person with schizophrenia in general but also in clinical situations we thought particularly involved in disagreements. RESULTS We recruited a population of 17 psychiatrists, mostly males of average age of 58 years, working mostly in the department of adult psychiatry of a hospital. We highlighted the differences between the experts, first with regards to the issue of liability in general. Experts divided seemed to keep in majority (52.9 %) the alternative between abolition and alteration of discernment when faced with a schizophrenic person accused of murder. The differences were even more pronounced in specific contexts. Thus, the fact that the person had suffered from delirium at the time of the offense led half of the experts (47.1 %) to conclude a systematic abolition of discernment, while the other half made such a conclusion when the delirium was directly linked to the facts. Discontinuation of neuroleptic treatment, drug abuse or existence of premeditation changed the conclusions of the experts in half the cases, more in the sense of an increased accountability in the cases of drug abuse or premeditation, and in the direction of a reduction of liability in case of cessation of treatment. The denial of facts by the accused caused fewer disagreements between experts. Among experts, 76.5 % had already observed differences, which, according to them, were based primarily on schools of thought, or personal views (64.7 %), which could distort clinical evaluation and especially forensic interpretation of the relationship between pathology and facts. The experts thought it was possible and desirable to reduce differences and proposed different solutions for this, especially the return to dual expertise and colleges of experts. DISCUSSION Our results were consistent with those in the literature. Based on proposals from experts and data from the literature, we identified five perspectives likely to reduce differences: first it would be useful to put in place a better specific training in forensic psychiatry and expertise, not only theoretical but also in terms of practical training through tutoring. We would identify a jurisprudence in forensic psychiatric assessment and identify consensual points. It would be good to allow experts to acquire sufficient experience not just through tutorials but also by statutory changes. Moments of exchange between experts - including a return to dual expertise and the organization of work meeting - could also reduce differences. Finally, we propose legislative changes: not only to rewrite the paragraph 2 of Article 122-1 of the French Penal Code, but also to give priority to the expertise of responsibility on the expertise of dangerousness. CONCLUSION We showed that there were differences between the experts mainly concerned with the forensic interpretation, and that they seemed linked to schools of thought or to personal views of each expert. To reduce the differences, we discussed five perspectives.
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Affiliation(s)
- J Guivarch
- Service de pédopsychiatrie, CHU Sainte-Marguerite, 270, boulevard de Sainte-Marguerite, 13274 Marseille cedex 9, France.
| | - M-D Piercecchi-Marti
- Service de médecine légale et droit de la santé, CHU Timone, 13385 Marseille cedex 5, France; CNRS, EFS, ADES UMR 7268, Aix-Marseille université, 13916 Marseille, France
| | - D Glezer
- CRIR AVS PACA, CHU Sainte-Marguerite, 270, boulevard de Sainte-Marguerite, 13274 Marseille cedex 9, France
| | - J-M Chabannes
- Service de psychiatrie, CHU La Conception, secteur 13G04, 147, boulevard Baille, 13385 Marseille cedex 5, France
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Guivarch J, Piercecchi-Marti MD, Glezer D, Chabannes JM. Divergences dans l’expertise psychiatrique de responsabilité : bilan et premières hypothèses à travers une revue de la littérature. Encephale 2015; 41:244-50. [DOI: 10.1016/j.encep.2015.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 09/03/2014] [Indexed: 11/27/2022]
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Abstract
The received wisdom is that there is no known effective treatment for psychopathic disorders. Although outcome studies have not identified an effective programmatic treatment for psychopathic disorders, such studies tend to leave the question open. If behavioral science has not established that psychopathic disorders respond to a particular programmatic approach, neither are psychopathic disorders convincingly proven to be absolutely resistant to treatment. If no treatment is known to be effective in psychopathic disorders, then any treatment seems to squander resources. What is often missing from the discussion is effective therapeutic measures to treat other behaviors that often co-occur, if they do not represent a domain of pathology of psychopathic disorders, such as impulsive aggression. After a brief summary of results of programmatic treatment of psychopathic offenders, this review focuses on the pharmacotherapy of impulsive aggression in psychopathic disorders. If the impulsive aggression that occurs with psychopathic disorders can be better controlled, treatment can have substantial benefits and would be most appropriate.
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Schreiber J, Green D, Kunz M, Belfi B, Pequeno G. Offense Characteristics of Incompetent to Stand Trial Defendants Charged With Violent Offenses. BEHAVIORAL SCIENCES & THE LAW 2015; 33:257-278. [PMID: 25827534 DOI: 10.1002/bsl.2174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The current study compared offender and offense characteristics of pretrial defendants found incompetent to stand trial (IST) against those described as general offenders by victims in the 2008 Bureau of Justice Statistics (BJS) survey and evaluated factors that differentiated IST defendants who allegedly used weapons from those who did not during the course of a violent offense. IST defendants were older and used "weapons" more frequently than those reported in the BJS survey; however, other characteristics, including use of firearms, did not differ. No demographic, clinical, or legal factors differentiated pretrial defendants who used weapons from those who did not. Overall, pretrial defendants were frequently diagnosed with a comorbid substance use disorder, and were homeless, unemployed, and had an extensive history of psychiatric hospitalizations and prior arrests at the time of their alleged offenses. Such results indicate that models for comprehensive discharge planning may have utility in addressing the unique needs of this subgroup of mentally disordered offenders. The findings also raise questions about the federal and state prohibition of gun rights to all IST defendants.
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Affiliation(s)
- Jeremy Schreiber
- Fairleigh Dickinson University, School of Psychology, Teaneck, NJ
| | - Debbie Green
- Fairleigh Dickinson University, School of Psychology, Teaneck, NJ
| | - Michal Kunz
- Kirby Forensic Psychiatric Center/New York University School of Medicine, New York, NY
| | - Brian Belfi
- Kirby Forensic Psychiatric Center/New York University School of Medicine, New York, NY
| | - Gabriela Pequeno
- Fairleigh Dickinson University, School of Psychology, Teaneck, NJ
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The relationship of perceived family criticism and other risk factors to violence among patients with schizophrenia. MIDDLE EAST CURRENT PSYCHIATRY 2015. [DOI: 10.1097/01.xme.0000461768.22702.35] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
Convincing evidence demonstrates that psychopathy is associated with premeditated aggression. However, studies have failed to explain why this association exists and whether socio-cognitive functions, such as mentalizing, could explain the relation. This cross-sectional study investigates, in 108 patients with schizophrenia, the association of psychopathy and mentalizing abilities with premeditated and impulsive aggression and probes the nature of their influence on these specific aggression patterns. Patients' engagement in premeditated aggression was associated with diminishing mentalizing and increasing psychopathic tendencies. Moreover, mediation analyses reveal that the ability to attribute mental states to others mediates the relation between psychopathy and type of aggression. This mediation is facilitated by a specific mentalizing profile characterized by the presence of intact cognitive and deficient emotional mentalizing capacities. This study is the first to report a mediating effect of mentalizing on the relationship between psychopathy and type of aggression in schizophrenia. Implications of these results are discussed.
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17
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Goethals K, Van Giels M, Ekiz E, Van Marle H. Possible correlations between the deficient affective experience and negative symptoms of psychosis: an exploratory study in (forensic) psychiatric patients. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2013; 23:336-346. [PMID: 23907985 DOI: 10.1002/cbm.1872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 03/24/2013] [Accepted: 05/14/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Deficient affective experience (DAE), the affective and perhaps fundamental component of psychopathy, has some resemblance to the core affective disturbances of schizophrenia. There has, however, been little attempt to test relationships between these concepts, but this could be useful because of the high prevalence of schizophrenia among people in forensic mental health services and evidence that the DAE may be a useful predictor of violent behaviour. AIMS Our primary aim was to explore possible correlations between DAE and negative symptoms of schizophrenia and to test the hypotheses that the DAE would differentiate people with and without personality disorder co-morbidity in a sample with psychosis and, separately, people with main diagnoses of personality disorder or schizophrenia. METHOD On the basis of an interview and a review of institutional files, DAE total and facet scores were calculated and compared with scores on the negative symptom scale of the Positive and Negative Syndrome Scale among forensic and general psychiatric patients. Partial correlation and rank order coefficients were calculated. RESULTS We found no correlation between total DAE scores and total negative Positive and Negative Syndrome Scale scores among patients with psychosis, suggesting that the concepts probably do not overlap. Our hypotheses on diagnostic associations with the DAE were partially sustained. DAE scores differentiated psychosis and personality disorder groups but did not differentiate psychosis groups with and without personality pathology. CONCLUSIONS AND IMPLICATIONS This study, using typical clinical samples, suggested that one aspect of the affective disturbance of schizophrenia has little in common with the deficient emotional experience of psychopath. Measurement of DAE is unlikely to help detect co-morbid personality disorder among people with psychosis, but given our small sample size and the rarity of study in this field, further research would be warranted, perhaps also including a measure of incongruity of affect.
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Affiliation(s)
- Kris Goethals
- Department of Forensic Psychiatry, Mental Health Care Westelijk Noord-Brabant, Halsteren, The Netherlands; Antwerp University Hospital, University Forensic Centre, Edegem, Belgium; Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
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18
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Pompili M, Serafini G, Innamorati M, Biondi M, Girardi N, Murri MB, Amore M, Lester D, Girardi P. Impulsivity, Aggression, and Suicide Risk in Patients with Schizophrenia. Psychiatr Ann 2013. [DOI: 10.3928/00485713-20131003-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ross RG, Maximon J, Kusumi J, Lurie S. Violence in childhood-onset schizophrenia. Ment Illn 2013; 5:e2. [PMID: 25478126 PMCID: PMC4253386 DOI: 10.4081/mi.2013.e2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Revised: 09/21/2012] [Accepted: 11/06/2012] [Indexed: 11/28/2022] Open
Abstract
Violence is elevated in older adolescents and adults with schizophrenia; however, little is known about younger children. This report focuses on rates of violence in younger children with schizophrenic-spectrum illnesses. A retrospective review of structured diagnostic interviews from a case series of 81 children, ages 4-15 years of age, with childhood onset of schizophrenic-spectrum illness is reported. Seventy-two percent of children had a history of violent behavior, including 25 children (31%) with a history of severe violence. Of those with a history of violence, 60% had a least one episode of violence that did not appear to be in response to an external stimulus (internally driven violence). There was no significant impact of age or gender. For many children, these internally driven violent episodes were rare and unpredictable, but severe. Similar to what is found in adolescents and adults, violence is common in children with schizophrenic-spectrum illnesses. General violence prevention strategies combined with early identification and treatment of childhood psychotic illnesses may decrease the morbidity associated with childhood psychotic violence.
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Affiliation(s)
- Randal G. Ross
- Department of Psychiatry, University of Colorado Denver, Aurora, CO, USA
| | - Julia Maximon
- Department of Psychiatry, University of Colorado Denver, Aurora, CO, USA
| | - Jonathan Kusumi
- Department of Psychiatry, University of Colorado Denver, Aurora, CO, USA
- Department of Psychiatry, Denver Health and Hospitals, Denver, CO, USA
| | - Susan Lurie
- Department of Psychiatry, University of Colorado Denver, Aurora, CO, USA
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Doihara C, Kawanishi C, Ohyama N, Yamada T, Nakagawa M, Iwamoto Y, Odawara T, Hirayasu Y. Trait impulsivity in suicide attempters: preliminary study. Psychiatry Clin Neurosci 2012; 66:529-32. [PMID: 22989319 DOI: 10.1111/j.1440-1819.2012.02379.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Suicide attempt is a risk factor for suicide. To investigate trait impulsivity among suicide attempters, 93 attempters admitted to an emergency department and 113 healthy controls were evaluated using the Japanese version of the Barratt Impulsiveness Scale (BIS-11J). Impulsivity was analyzed in relation to clinical data in the attempters. Total BIS-11J, attention impulsiveness, and motor impulsiveness scores were significantly higher in the attempters than in the controls. Both total BIS-11J and non-planning impulsiveness scores were significantly higher in attempters with schizophrenia and other psychotic disorders among the diagnostic groups. Control of impulsivity should be considered as one of the targets for suicide prevention.
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Affiliation(s)
- Chiho Doihara
- Health Management and Promotion Centre, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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21
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Felthous AR. The "untreatability" of psychopathy and hospital commitment in the USA. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2011; 34:400-405. [PMID: 22079085 DOI: 10.1016/j.ijlp.2011.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
One argument in support of a public policy of not subjecting persons with psychopathic disorders to civil or criminal commitment is that these disorders do not improve with treatment. This article examines the relationship between the assumption of untreatability of psychopathic disorders and outpatient civil commitment, inpatient civil commitment, and insanity acquittee commitment. Research on the treatability of psychopathy is reviewed and the treatment of conditions co-morbid with psychopathy is considered. Research evidence is insufficient to support the conclusion that psychopathy is improved, worsened or not affected by treatment. Evidence does support effective treatments for conditions that can be co-morbid with psychopathic disorders including impulsive aggression which can be interpreted as a manifestation of psychopathic disorder. The absence of evidence based treatment efficacy for psychopathic disorders is a logical reason for not subjecting individuals with only a psychopathic disorder to involuntary hospitalization. This assumption should not becloud the possibility of treatable co-morbid conditions which may or may not qualify for involuntary hospitalization. Where the primary mental disorder, for which an individual is involuntarily hospitalized, results in behavioral improvement, the continued presence of a psychopathic disorder itself, should not be sufficient reason to continue coerced confinement. Even so, where the primary disorder is incompletely treated, psychopathy can be considered a risk factor when deciding upon the appropriate time for discharge and when formulating a safe and effective after care plan.
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Affiliation(s)
- Alan R Felthous
- Forensic Psychiatry Division, Department of Neurology & Psychiatry, Saint Louis University School of Medicine, 1438 South Grand Blvd., Saint Louis, MO 63104, USA.
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Bo S, Abu-Akel A, Kongerslev M, Haahr UH, Simonsen E. Risk factors for violence among patients with schizophrenia. Clin Psychol Rev 2011; 31:711-26. [PMID: 21497585 DOI: 10.1016/j.cpr.2011.03.002] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 02/24/2011] [Accepted: 03/02/2011] [Indexed: 10/18/2022]
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23
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Nakagawa M, Kawanishi C, Yamada T, Sugiura K, Iwamoto Y, Sato R, Morita S, Odawara T, Hirayasu Y. Comparison of characteristics of suicide attempters with schizophrenia spectrum disorders and those with mood disorders in Japan. Psychiatry Res 2011; 188:78-82. [PMID: 20952076 DOI: 10.1016/j.psychres.2010.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 08/31/2010] [Accepted: 09/17/2010] [Indexed: 10/18/2022]
Abstract
Suicidality in patients with schizophrenia is high. To clarify the characteristics of suicidal behavior in patients with schizophrenia, we investigated suicide attempters with schizophrenia spectrum disorders in comparison with patients with mood disorders. One hundred patients with schizophrenia spectrum disorders and 155 patients with mood disorders admitted to an emergency department after a suicide attempt were interviewed in detail on items concerning 1) demographic characteristics, 2) previous suicidal behavior, and 3) index suicidal behavior. Differences between the two groups were subsequently analyzed. Patients with schizophrenia spectrum disorders showed a lower incidence of previous deliberate self-harm, and a higher incidence of a subsequent suicide attempt more than 1 year after the previous suicide attempt as well as a higher lethality of index suicide attempt compared to patients with mood disorders. Furthermore, the most common motive for making a suicide attempt in patients with schizophrenia spectrum disorders was having a mental problem. This study revealed the factors associated with suicide attempts among Japanese patients with schizophrenia spectrum disorders, and the nature of these factors makes it difficult to predict future attempts. This makes clear the importance of continuous long-term follow-up with careful attention to the mental symptoms and psychological burden for such patients.
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Affiliation(s)
- Makiko Nakagawa
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan.
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