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Balcioglu YH, Golenkov AV, Yildiz A, Uzlar RD, Oncu F. Homicide perpetrators with psychotic illness found not criminally responsible in Turkiye and Russia: An international comparison. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2024; 93:101962. [PMID: 38330511 DOI: 10.1016/j.ijlp.2024.101962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/27/2024] [Accepted: 02/02/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE The primary objective was to conduct a comparative analysis of homicide cases and their perpetrators with psychotic illnesses in samples from Turkiye and Russia to elucidate contextual similarities and differences, and providing novel perspectives to enhance international research in this field. METHOD This cross-national retrospective study, conducted at forensic psychiatric centers in Istanbul, Turkiye, and Chuvashia, Russia, involved individuals with psychotic illnesses (ICD-10 F20-F29) who were deemed criminally non-responsible for index homicide offenses between December 2012 and December 2022. The sample included 92 Turkish patients and 29 Russian patients who were compared for background, clinical characteristics, and each homicidal act. RESULTS Binary analyses revealed that Russian subjects were more educated, had more lifetime suicide attempts, longer illness duration, had acquaintances as victims more frequently, higher rates of blunt traumatic homicides, higher rates of intoxication with alcohol or substances, and lower rates of experiencing delusions at the time of the index homicide compared to their Turkish counterparts. Multivariate analyses indicated that more years of education, a greater frequency of lifetime suicide attempts, higher prevalence of intoxication and a lower rate of delusions at the time of the homicide were associated with belonging to the Russian group. CONCLUSION Despite several similarities, the remarkable differences between the two samples underscore the importance of international research in enhancing our understanding of mental health, homicidal offense and offender characteristics in the sociocultural context.
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Affiliation(s)
- Yasin Hasan Balcioglu
- Forensic Psychiatry Unit, Bakirkoy Prof Mazhar Osman Training and Research Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul, Turkiye.
| | - Andrei Vasilyevich Golenkov
- Department of Psychiatry and Medical Psychology, Chuvash State University, Cheboksary, Republic of Chuvashia, Russian Federation
| | - Alperen Yildiz
- Forensic Psychiatry Unit, Bakirkoy Prof Mazhar Osman Training and Research Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul, Turkiye
| | - Rustem Dogan Uzlar
- Forensic Psychiatry Unit, Bakirkoy Prof Mazhar Osman Training and Research Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul, Turkiye
| | - Fatih Oncu
- Forensic Psychiatry Unit, Bakirkoy Prof Mazhar Osman Training and Research Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul, Turkiye
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Bo S, Sharp C, Lind M, Simonsen S, Bateman A. Mentalizing mediates the relationship between psychopathy and premeditated criminal offending in schizophrenia: a 6-year follow-up study. Nord J Psychiatry 2023; 77:547-559. [PMID: 36897045 DOI: 10.1080/08039488.2023.2186483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/09/2023] [Accepted: 02/23/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE Research has shown that schizophrenia augments the risk for criminal behaviour and variables both defining- and related to schizophrenia, increase criminal offending. Premeditated criminal offending is considered a severe form of criminal offending, however, very little is known about what predicts future premeditated criminal offending in schizophrenia. METHOD AND MATERIALS In this 6-year follow-up study we explored which factors underlie future premeditated criminal behaviour in a sample of patients diagnosed with schizophrenia (N = 116). We also investigated if a specific mentalizing profile underlie part of the variance of premeditated criminal offending. RESULTS Results showed that psychopathy underlie future premeditated crime in schizophrenia, and that a specific mentalizing profile, comprised of a dysfunctional emotional and intact cognitive mentalizing profile in relation to others, mediated parts of the relation between psychopathy and premeditated criminal offending. Finally, our results indicated that patients with schizophrenia with a specific mentalizing profile (see above) engaged in premeditated criminal behaviour earlier during the 6-year follow-up period compared to patients with other mentalizing profiles. CONCLUSIONS Our findings suggest that mentalization should carefully be inspected in patients with schizophrenia in relation to future premeditated offending.
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Affiliation(s)
- Sune Bo
- Department of Psychology, University of Copenhagen, DK and Department of Psychiatry, Denmark
| | - Carla Sharp
- Department of Psychology, University of Houston, USA
| | - Majse Lind
- Department of Psychology, University of Aalborg, Denmark
| | - Sebastian Simonsen
- Department of Psychology, University of Copenhagen, and Stolpegaard Psychotherapy Centre, Denmark
| | - Anthony Bateman
- Psychoanalysis Unit, University College London, United Kingdom
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Castelletti L, Iozzino L, Zamparini M, Heitzman J, Markiewicz I, Nicolò G, Picchioni M, Restuccia G, Rivellini G, Teti F, Wancata J, de Girolamo G. Difference between forensic patients with schizophrenia spectrum disorders in Italy and other European countries: Results of the EU-VIORMED project. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2023. [PMID: 37464578 DOI: 10.1002/cbm.2302] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 06/22/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND There has been a substantial change in the law on the provision of secure health services for offender-patients in Italy, a country currently with the lowest general psychiatry bed availability per head of the population in Europe, raising questions about possible differences in offender-patient admissions between European countries. AIMS In this multicentre case-control study, our aim was to compare the socio-demographic, clinical and criminological characteristics of a sample of Italian forensic in-patients with schizophrenia or similar psychosis with patients in a similar diagnostic range in specialist in-patient services elsewhere in Europe. METHODS Secure hospital unit in-patients with psychosis were recruited across five European countries (Italy, Austria, Germany, Poland and England). Consenting patients were interviewed by researchers and assessed using a multidimensional standardised process. Within country similarities between Austria, Germany, Poland and England were confirmed. RESULTS Overall, 39 Italian participants had had fewer years of education than the 182 patients in the other countries and were less likely to have ever had skilled or professional employment. The Italian patients had been older at first contact with any mental health services than the other Europeans. Diagnosed comorbidity rates were similar, but the Italian group reported higher levels of disability. Although the other European forensic patients were more likely to be undergoing treatment at the time of their index offence, they were also more likely to have been poorly compliant with treatment. The rate of suicide-related behaviours was significantly lower among the Italian patients than among the others. CONCLUSIONS Notwithstanding similar diagnoses, important differences emerged between patients in Italian forensic mental health resident services and those in four other European countries, some possibly reflecting less access to earlier relevant services in Italy. Others, including lower disability ratings among the Italian patients and a lower rate of suicide-related behaviours, may indicate that the Italian reforms carry benefits. This is worthy of further evaluation.
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Affiliation(s)
- Luca Castelletti
- Department of Mental Health and Pathological Dependency, AUSL Reggio Emilia, REMS, Reggio Emilia, Italy
| | - Laura Iozzino
- Psychiatric Epidemiology and Evaluation Unit, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Manuel Zamparini
- Psychiatric Epidemiology and Evaluation Unit, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Janusz Heitzman
- Department of Forensic Psychiatry, Instytut Psychiatrii I Neurologii, Warszawa, Poland
| | - Inga Markiewicz
- Department of Forensic Psychiatry, Instytut Psychiatrii I Neurologii, Warszawa, Poland
| | | | - Marco Picchioni
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- St Magnus Hospital, Surrey, UK
| | | | | | - Fabio Teti
- ASST, Mantova, Sistema Polimodulare REMS, Mantova, Italy
| | - Johannes Wancata
- Clinical Division of Social Psychiatry, Medical University of Vienna, Wien, Austria
| | - Giovanni de Girolamo
- Psychiatric Epidemiology and Evaluation Unit, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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Hodgins S, Eronen M, Freese R, Hart S, Mueller-Isberner R, Ross D, Webster C, Tiihonen J. Correspondence regarding De Girolamo et al., 2021 'A multinational case-control study comparing forensic and non-forensic patients with schizophrenia spectrum disorders: the EU-VIORMED project'. Psychol Med 2023; 53:3764-3765. [PMID: 34725013 DOI: 10.1017/s0033291721004347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Sheilagh Hodgins
- Département de Psychiatrie et Addictologie, Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Markku Eronen
- Department of Psychiatry, Vanha Vaasa hospital, Vaasa Central Hospital, Forensic Psychiatry, University of Turku, University of Helsinki, Finland
| | | | - Stephen Hart
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | | | - Deborah Ross
- BC Mental Health and Substance Use Services, Vancouver, British Columbia, Canada
| | - Christopher Webster
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
- Department of Psychiatry, University of Toronto, Child Development Institute, Toronto
- Child and Youth Care, University of Victoria, Canada
| | - Jari Tiihonen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Finland
- Department of Clinical Neuroscience, Karolinska Institutet and Stockholm County Council, Sweden
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Watts D, Mamak M, Moulden H, Upfold C, de Azevedo Cardoso T, Kapczinski F, Chaimowitz G. The HARM models: Predicting longitudinal physical aggression in patients with schizophrenia at an individual level. J Psychiatr Res 2023; 161:91-98. [PMID: 36917868 DOI: 10.1016/j.jpsychires.2023.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 02/14/2023] [Accepted: 02/23/2023] [Indexed: 03/16/2023]
Abstract
The prediction and prevention of aggression in individuals with schizophrenia remains a top priority within forensic psychiatric settings. While risk assessment methods are well rooted in forensic psychiatry, there are no available tools to predict longitudinal physical aggression in patients with schizophrenia within forensic settings at an individual level. In the present study, we used evidence-based risk and protective factors, as well as variables related to course of treatment assessed at baseline, to predict prospective incidents of physical aggression (4-month, 12-month, and 18-month follow-up) among 151 patients with schizophrenia within the forensic mental healthcare system. Across our HARM models, the balanced accuracy (sensitivity + specificity/2) of predicting physical aggressive incidents in patients with schizophrenia ranged from 59.73 to 87.33% at 4-month follow-up, 68.31-80.10% at 12-month follow-up, and 46.22-81.63% at 18-month follow-up, respectively. Additionally, we developed separate models, using clinician rated clinical judgement of short term and immediate violent risk, as a measure of comparison. Several modifiable evidence-based predictors of prospective physical aggression in schizophrenia were identified, including impulse control, substance abuse, impulsivity, treatment non-adherence, mood and psychotic symptoms, substance abuse, and poor family support. To the best of our knowledge, our HARM models are the first to predict longitudinal physical aggression at an individual level in patients with schizophrenia in forensic settings. However, it is important to caution that since these machine learning models were developed in the context of forensic settings, they may not be generalisable to individuals with schizophrenia more broadly. Moreover, a low base rate of physical aggression was observed in the testing set (6.0-11.6% across timepoints). As such, larger cohorts will be required to determine the replicability of these findings.
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Affiliation(s)
- Devon Watts
- Neuroscience Graduate Program, McMaster University, Hamilton, Canada.
| | - Mini Mamak
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
| | - Heather Moulden
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
| | - Casey Upfold
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
| | | | - Flavio Kapczinski
- Neuroscience Graduate Program, McMaster University, Hamilton, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil.
| | - Gary Chaimowitz
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
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Hodgins S. Female Forensic Patients May Be an Atypical Sub-type of Females Presenting Aggressive and Antisocial Behavior. Front Psychiatry 2022; 13:809901. [PMID: 35222118 PMCID: PMC8869424 DOI: 10.3389/fpsyt.2022.809901] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/17/2022] [Indexed: 01/24/2023] Open
Abstract
The percentage of forensic psychiatric patients who are female varies from 5 to 13% in Europe, rises to 18% in England and Wales, and sits at 15% in Canada. Similarly, many fewer women than men are incarcerated in correctional facilities. While these statistics supposedly reflect less antisocial and aggressive behavior (AAB) among females than males, not all findings support this supposition. Data from prospective longitudinal studies show that aggressive and antisocial behavior onsets in childhood, and in a small group of females it remains stable across the life-span. Unlike similar males, few of these females are convicted of crimes. This article begins with a review of descriptive studies of females sentenced by criminal courts to treatment in forensic psychiatric hospitals and moves on to present evidence showing that most female AAB does not lead to criminal prosecution. Next, studies of female AAB are reviewed, noting that it onsets in early childhood and, that in a small group remains stable across the life-span. Subsequent sections of the article focus on the two most common mental disorders presented by female forensic patients, schizophrenia and borderline personality disorder, highlighting what is known about the sub-groups of women with these disorders who present AAB. The article concludes with recommendations for earlier identification by psychiatric services of women presenting mental disorders and AAB, treatments to reduce both the symptoms of their mental disorders and their life-long AAB, and the research that is needed in order to improve the effectiveness of these treatments. The real possibilities of prevention of the development of AAB, and even perhaps aspects of the mental disorders that plague female forensic patients, are described.
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Affiliation(s)
- Sheilagh Hodgins
- Département de Psychiatrie et Addictologie, Université de Montréal, et Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada.,Haina Forensic Psychiatric Institute, Haina, Germany
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Marazia C, Rucci P, Fangerau H, Voßberg D, Rolfes V, Iozzino L, Iommi M, Gosek P, Heitzman J, Ferrari C, Macis A, Markiewicz I, Picchioni M, Salize HJ, Stompe T, Wancata J, Appelbaum PS, de Girolamo G. Treatment Decision-Making Capacity in Forensic vs Non-forensic Psychiatric Patients: A European Comparison. SCHIZOPHRENIA BULLETIN OPEN 2022; 3:sgac037. [PMID: 39144784 PMCID: PMC11205899 DOI: 10.1093/schizbullopen/sgac037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Background Consent to treatment is a cornerstone of medical ethics and law. Nevertheless, very little empirical evidence is available to inform clinicians and policymakers regarding the capacities of forensic patients with schizophrenia spectrum disorders (SSDs) to make decisions about their treatment, with the risk of clinical and legal inertia, silent coercion, stigmatization, or ill-conceived reforms. Study Design In this multinational study, we assessed and compared with treatment-related decisional capacities in forensic and non-forensic patients with SSD. 160 forensic and 139 non-forensic patients were used in Austria, Germany, Italy, Poland, and England. Their capacity to consent to treatment was assessed by means of the MacArthur Competence Assessment Tool for Treatment (MacCAT-T). Multiple generalized linear regression models were used to identify the socio-demographic and clinical variables associated with MacCAT-T scores. Study Results In total, 55 forensic (34.4%) and 58 non-forensic patients (41.7%) showed high treatment-related decisional capacity, defined as scoring ≥75% of the maximum scores for the understanding, appreciation and reasoning, and 2 for expressing a choice. Forensic patients showed differences in their capacity to consent to treatment across countries. Of all socio-demographic and clinical variables, only "social support" was directly relevant to policy. Conclusions Forensic patients have treatment-related decisional capacities comparable with their non-forensic counterparts. Social contacts might provide a substantial contribution towards enhancing the decisional autonomy of both forensic and non-forensic patients, hence improving the overall quality and legitimacy of mental health care.
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Affiliation(s)
- Chantal Marazia
- Department of the History, Philosophy and Ethics of Medicine, Medical Faculty, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Heiner Fangerau
- Department of the History, Philosophy and Ethics of Medicine, Medical Faculty, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany
| | - Dilara Voßberg
- Department of the History, Philosophy and Ethics of Medicine, Medical Faculty, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany
| | - Vasilija Rolfes
- Department of the History, Philosophy and Ethics of Medicine, Medical Faculty, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany
| | - Laura Iozzino
- Unit of Epidemiological Psychiatry and Evaluation, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Marica Iommi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Pawel Gosek
- Department of Forensic Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Janusz Heitzman
- Department of Forensic Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Clarissa Ferrari
- Unit of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Ambra Macis
- Unit of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Inga Markiewicz
- Department of Forensic Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Marco Picchioni
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- St Magnus Hospital, Haslemere, UK
| | - Hans Joachim Salize
- Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Heidelberg, Germany
| | - Thomas Stompe
- Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Johannes Wancata
- Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Paul S Appelbaum
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Giovanni de Girolamo
- Unit of Epidemiological Psychiatry and Evaluation, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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