Mental illness and sexual offending

Differentiating Between Sexual Offending and Violent Non-sexual Offending in Men With Schizophrenia Spectrum Disorders Using Machine Learning

Forensic psychiatric populations commonly contain a subset of persons with schizophrenia spectrum disorders (SSD) who have committed sex offenses. A comprehensive delineation of the features that distinguish persons with SSD who have committed sex offenses from persons with SSD who have committed violent non-sex offenses could be relevant to the development of differentiated risk assessment, risk management and treatment approaches. This analysis included the patient records of 296 men with SSD convicted of at least one sex and/or violent offense who were admitted to the Centre for Inpatient Forensic Therapy at the University Hospital of Psychiatry Zurich between 1982 and 2016. Using supervised machine learning, data on 461 variables retrospectively collected from the records were compared with respect to their relative importance in differentiating between men who had committed sex offenses and men who had committed violent non-sex offenses. The final machine learning model was able to differentiate between the two types of offenders with a balanced accuracy of 71.5% (95% CI = [60.7, 82.1]) and an AUC of .80 (95% CI = [.67, .93]). The main distinguishing features included sexual behaviours and interests, psychopathological symptoms and characteristics of the index offense. Results suggest that when assessing and treating persons with SSD who have committed sex offenses, it appears to be relevant to not only address the core symptoms of the disorder, but to also take into account general risk factors for sexual recidivism, such as atypical sexual interests and sexual preoccupation.

Psychiatric disorders and management of sexual offenders in the prison psychiatric consultation unit of Marseille

Since 2017, complaints of sexual violence have increased in France. At the same time, the management of sexual offenders has been at the center of international public health policies. The prevalence of mental disorders among sexual offenders is an essential field of research. There are some published studies on the prevalence of psychiatric disorders in sexual offenders in detention, but there are few recent published studies among French individuals who were detained. Our objectives were to determine the prevalence of psychiatric disorders among persons detained for sexual offenses and the level of care received according to their diagnosis. For this purpose, we carried out a retrospective observational study from January 2017 to October 2021 of all adult sexual offenders, whether accused or convicted, who were seen in the psychiatric consultation unit of Les Baumettes prison, Marseille, France. The primary outcome measure was the psychiatric diagnosis entered in the medical records. One hundred forty-two patients were included in analysis. All patients were men, and the majority (n = 97, 68.3%) of these patients presented with at least one psychiatric disorder, principally a personality disorder (31.7%). 10.6% presented with a schizophrenic disorder, 4.9% a bipolar disorder, 3.5% a depressive disorder, 5.6% pedophilic paraphilia, and 25.4% an addictive disorder. Their management and comorbid addictions were analyzed in subgroups for each psychiatric disorder. Patients appeared to receive an appropriate level of care for their diagnosed disorder. It seems important to develop structured assessment of recidivism risk for better management of sexual offenders.

A 24-Year Follow-up Study on Recidivism in Male Mentally Disordered Sexual Offenders With and Without Psychotic Disorders

There is a lack of knowledge on mentally disordered sex offenders (MDSOs) targeting adult victims, especially regarding recidivism patterns and the specific subgroup with psychiatric disorders. This paper presents index offense data, clinical data, and recidivism patterns over up to 24 years in a cohort of 146 MDSOs, with and without psychotic disorders, sentenced in Sweden between 1993 and 1997. At the time of the offense, all offenders were affected by clinical, developmental, and criminal history factors. MDSOs with psychotic disorders only marginally differed from those without, the former being less likely to have been institutionalized during childhood, intoxicated during the index offense, or diagnosed with a personality disorder, substance use disorder, or paraphilic disorder. In the cohort, 3.4% of the MDSOs were reconvicted for a new sex offense over 2 years, 9.6% over 5 years, 13.0% over 10 years, and 17.1% over the entire follow-up period of 24 years. In MDSOs with psychotic disorders, no subjects were reconvicted during the first 2 years, while 2.6% were reconvicted over 5 years, 5.3% over 10 years, and 7.9% over 24 years. Recidivism rates for violent and general reoffenses were 39.0% and 37.7%, respectively, for the cohort of MDSOs, and subjects with psychotic disorders reoffended significantly later in general offenses. In conclusion, MDSOs with psychotic disorders showed the same recidivism pattern as MDSOs without psychotic disorders. Furthermore, recidivism research may preferably focus on follow-up periods of 5-10 years since most offenders appear to recidivate within this timeframe.

Psychosis and Sexual Offending: A Review of Current Literature

Sexual offending is a public health concern and societal risk requiring a multi-disciplinary approach. While current data give an indication of the frequency of sexual victimization, these figures likely underestimate the severity of the concern as many of these incidents go unreported. And while sex offender research has increased over the past several decades, particular attention to those offenders with severe mental illness remains limited. In this descriptive review, literature describing sex offenders with psychotic disorders is explored with a focus on recent research. Important considerations are described, including theories surrounding psychosis and sexual offending, hospitalization rates, recidivism, not guilty by reason of insanity (NGRI), female offenders, and treatment considerations. By exploring these important aspects of sex offenders with psychosis, conclusions are drawn and future directions are proposed, with a particular emphasis on clinical application for the mental health treatment provider.

Major Mental Illness in Those Who Sexually Abuse

PURPOSE OF REVIEW

There is evidence showing an increasing prevalence of mental illness in those in conflict with the law. However, there are many factors affecting the detection, treatment, and management of criminals who are mentally ill.

RECENT FINDINGS

Sex offenders with major mental illness present many challenges to those providing treatment and management services. For example, it is important to consider whether sexually offensive behavior is the cause of criminal behavior or whether it is reflective of an antisocial orientation. Recent evidence suggests it may help better understand and inform risk assessment and management. This paper will review the literature on mental illness among sexual offenders, present a typology to aid in the assessment, treatment, and management of sexual offender with mental illness, and highlight important considerations when providing treatment to sexual offenders with mental illness.

["Attention deficit hyperactivity disorder in forensic psychiatry: A review"]

INTRODUCTION

Attention deficit hyperactivity disorder (ADHD) is one of the most common and challenging childhood neurobehavioral disorders. ADHD may have behavioral consequences and involvements in minor and serious crimes. Our work aims to establish links between ADHD and forensic psychiatry.

METHODS

A review of international scientific literature concerning the relationship between ADHD and forensic psychiatry was conducted using the PudMed electronic database. We used the Mesh terms: "attention deficit hyperactivity disorder" and "forensic psychiatry". We also used the "related articles" function of PubMed, the bibliography of selected articles and the Google Scholar database to identify possible additional papers.

RESULTS

The prevalence of ADHD in prison populations may vary but remain higher than those found in the general population. Violence committed by a person with ADHD seems to be against other persons rather than property offences. Reactive-impulsive violence seems to be more prevalent than pro-active instrumental violence. The existence of ADHD does not appear as a risk factor of recidivism. The violence risk may be increased by the occurrence of comorbidities as conduct disorders and mental deficiency. There may exist a preferential association between ADHD and antisocial personality disorder or substance abuse which both increase the risk of violence.

DISCUSSION

To put in perspective forensic psychiatry and ADHD allowed us to identify typology of violence, epidemiological aspect of ADHD in a prison environment and comorbidities involved in the risk of violence. This research permits to precise elements of prevention, diagnosis and assistance in the management of violent behaviour in ADHD and in expert practice.

Elderly Sexual Offenders

With the ever-aging population, the number of elderly sexual offenders are also on the rise. The courts and correctional system are increasingly faced with older individuals who have offended sexually. Previously, these older offenders were thought to be similar to younger sexual offenders. However, closer analysis suggests that many of these individuals pose a much lower risk to recidivate than the risk to recidivate of their younger counterparts. Still, an individualized approach to manage the risk of older offenders is required, as some may have particular risk factors relevant for their treatment and future stability, such as dementia or other mental health issues. Further, this population often has particular physical health issues and requires special consideration when being placed in the community. Assessment, treatment, and risk management in this special population of sexual offenders are discussed.

Autism spectrum disorder, attention-deficit hyperactivity disorder and offending

Purpose

– A wealth of research on autism spectrum disorders (ASD) and attention-deficit hyperactivity disorder (ADHD) has led to increased understanding and identification of each of these developmental disorders. Existing literature has sparked controversial discussions regarding whether aspects of ASD and ADHD predispose individuals to criminality. The purpose of this paper is to explore the link between these conditions and offending.

Design/methodology/approach

– A review of the literature on ASD, ADHD and offending was undertaken. This paper looks at the particular focus of the literature on the involvement of individuals with ADHD and ASD within the criminal justice system.

Findings

– There is some evidence of a link between ADHD and criminality. However, the relationship between ASD and offending is a little more difficult to ascertain. Complicating this further is the relatively unexplored subject of comorbid ASD/ADHD and criminal behaviour. This paper found that additional cognitive deficits and conduct problems are associated with comorbid ASD/ADHD, highlighting the need for further research and development of interventions.

Originality/value

– This paper seeks to examine whether predictions can be made with regards to what offending behaviour may look like in an individual with comorbid ASD/ADHD. This paper reviews the literature on offending in relation to both disorders to examine whether predictions can be made with regards to what the offending behaviour of an individual with ASD and ADHD may look like.

Inflammation and neuronal plasticity: a link between childhood trauma and depression pathogenesis

During the past two decades, there has been increasing interest in understanding and characterizing the role of inflammation in major depressive disorder (MDD). Indeed, several are the evidences linking alterations in the inflammatory system to Major Depression, including the presence of elevated levels of pro-inflammatory cytokines, together with other mediators of inflammation. However, it is still not clear whether inflammation represents a cause or whether other factors related to depression result in these immunological effects. Regardless, exposure to early life stressful events, which represent a vulnerability factor for the development of psychiatric disorders, act through the modulation of inflammatory responses, but also of neuroplastic mechanisms over the entire life span. Indeed, early life stressful events can cause, possibly through epigenetic changes that persist over time, up to adulthood. Such alterations may concur to increase the vulnerability to develop psychopathologies. In this review we will discuss the role of inflammation and neuronal plasticity as relevant processes underlying depression development. Moreover, we will discuss the role of epigenetics in inducing alterations in inflammation-immune systems as well as dysfunction in neuronal plasticity, thus contributing to the long-lasting negative effects of stressful life events early in life and the consequent enhanced risk for depression. Finally we will provide an overview on the potential role of inflammatory system to aid diagnosis, predict treatment response, enhance treatment matching, and prevent the onset or relapse of Major Depression.