| 1. |
- Grann, Martin, et al.
(författare)
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Methodological development : structured outcome assessment and community risk monitoring (SORM)
- 2005
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier BV. - 0160-2527 .- 1873-6386. ; 28:4, s. 442-456
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Tidskriftsartikel (refereegranskat)abstract
- This paper describes an effort to develop a clinical tool for the continuous monitoring of risk for violence in forensic mental health clients who have left their institutions and who are dwelling in the community on a conditional release basis. The model is called Structured Outcome Assessment and Community Risk Monitoring (SORM). The SORM consists of 30 dynamic factors and each factor in SORM is assessed in two ways: The current absence, presence or partial och intermittent presence of the factors, which is an actuarial (systematized and 'objective') assessment. Secondly, the risk effect, i.e. whether the presence/absence of factors currently increases, decreases or is perceived as unrelated to violence risk, is a clinical (or impressionistic) assessment. Thus, the factors considered via the SORM can be coded as risk factors or protective factors (or as factors unimportant to risk of violence) depending on circumstances that apply in the individual case. Further, the SORM has a built-in module for gathering idiographical information about risk-affecting contextual factors. The use of the SORM and its potential as a risk monitoring instrument is illustrated via preliminary data and case vignettes from an ongoing multicenter project. In this research project, patients leaving any of the 9 participating forensic hospitals in Sweden is assessed at release on a variety of static background factors, and the SORM is then administered every 30 days for 2 years.
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| 2. |
- Bodlund, Owe, et al.
(författare)
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Validation of the self-report questionnaire DIP-Q in diagnosing DSM-IV personality disorders : a comparison of three psychiatric samples.
- 1998
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Ingår i: Acta Psychiatrica Scandinavica. - : Wiley. - 0001-690X .- 1600-0447. ; 97:6, s. 433-9
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Tidskriftsartikel (refereegranskat)abstract
- The DSM-IV section of the DSM-IV and ICD-10 Personality Questionnaire (DIP-Q) was used to screen for personality disorders in 448 subjects from three clinical samples (general and forensic psychiatric patients and candidates for psychotherapy) and a sample of 139 healthy volunteers. Differences between the samples with regard to patterns of personality pathology in relation to concurrent Axis I disorders and sociodemographic variables were analysed. The prevalence of personality disorders according to DIP-Q was 14% among the healthy volunteers, compared to 59% in the general psychiatric sample, 68% in the forensic psychiatric sample and up to 90% among psychotherapy candidates. Moreover, from a dimensional perspective (i.e. the number of fulfilled Axis II criteria), all clinical groups differed significantly from the control group in all specified personality dimensions and clusters. Dimensional DIP-Q cluster scores also discriminated significantly between the three clinical samples. Unexpectedly, the odds ratio for an Axis II disorder was nearly five times higher among psychotherapy applicants than among general psychiatric patients, independent of concomitant Axis I disorders, gender or age. The strongest association between DIP-Q score and Axis I disorders was found for depressive disorders, which more than doubled the odds ratio for a personality disorder diagnosis. This association could result from high true comorbidity, but could also be due to the fact that a concomitant depressive state can increase self-reported personality difficulties. The high prevalence among psychotherapy candidates may to some extent reflect help-seeking exaggeration of problems. These are aspects to consider when using the DIP-Q, which overall appears to discriminate well between different samples.
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| 3. |
- Dernevik, Mats, et al.
(författare)
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Violent behaviour in forensic psychiatric patients: Risk assessment and different risk-management levels using the HCR-20
- 2002
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Ingår i: Psychology, Crime and Law. - : Informa UK Limited. - 1068-316X .- 1477-2744. ; 8:1, s. 93-111
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Tidskriftsartikel (refereegranskat)abstract
- There has been a growing optimism regarding the accuracy of structured instruments for violence risk assessment in mentally disordered offenders, However, several issues pertaining to forensic assessments of risk remains unsolved, one of which is the relationship between risk assessment and risk management. In this paper we argued that research that evaluate efforts to assess risk must take into account the level of risk management in the sample. We attempted to illustrate this using prospective follow-up data on the frequency and type of inpatient violent behaviours and their relationship to risk management within the context of care. Risk assessments were made upon admission to hospital with the Historical-Clinical-Risk assessment (HCR-20, Webster et al., 1997) in 54 forensic patients followed through three different risk management conditions: High security risk management, medium risk management, and only risk monitoring (low). The results showed large differences in baserate and type of violence in the three management conditions. Results also suggested that the HCR-20 accurately assessed risk in medium and low security conditions, but not in the high security condition. We conclude that the findings reinforce rather than contraindicate the usefulness of the HCR-20 in for clinical practice.
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| 4. |
- Fazel, Seena, et al.
(författare)
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Homicide in discharged patients with schizophrenia and other psychoses : a national case-control study.
- 2010
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Ingår i: Schizophrenia Research. - : Elsevier BV. - 0920-9964 .- 1573-2509. ; 123:2-3, s. 263-9
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate factors associated with homicide after discharge from hospital in patients with schizophrenia and other psychoses.DESIGN: All homicides committed by patients with psychosis within 6 months of hospital discharge were identified in Sweden from 1988-2001 and compared with patients with psychoses discharged over the same time period who did not subsequently commit any violent offences. Medical records were then collected, and data extracted using a validated protocol. Interrater reliability tests were performed on a subsample, and variables with poor reliability excluded from subsequent analyses.RESULTS: We identified 47 cases who committed a homicide within 6 months of discharge, and 105 controls who did not commit any violent offence after discharge. On univariate analyses, clinical factors on admission associated with homicide included evidence of poor self-care, substance misuse, and being previously hospitalized for a violent episode. Inpatient characteristics included having a severe mental illness for one year prior to admission. After-care factors associated with homicide were evidence of medication non-compliance and substance misuse. The predictive validity of combining two or three of these factors was not high. Depression appeared to be inversely associated with homicide, and there was no relationship with the presence of delusions or hallucinations.CONCLUSIONS: There are a number of potentially treatable factors that are associated with homicide in schizophrenia and other psychoses. Associations with substance misuse and treatment compliance could be the focus of therapeutic interventions if validated in other samples. However, their clinical utility in violence risk assessment remains uncertain.
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| 5. |
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| 6. |
- Fazel, Seena, et al.
(författare)
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Neurological disorders and violence : a systematic review and meta-analysis with a focus on epilepsy and traumatic brain injury
- 2009
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Ingår i: Journal of Neurology. - : Springer Science and Business Media LLC. - 0340-5354 .- 1432-1459. ; 256:10, s. 1591-1602
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Forskningsöversikt (refereegranskat)abstract
- The objectives of this study were to systematically review and meta-analyze the research literature on the association of common neurological disorders and violence. Keywords relating to neurological disorders and violence were searched between 1966 and August 2008. Case-control and cohort studies were selected. Odds ratios of violence risk in particular disorders compared with controls were combined using fixed-effects meta-analysis with the data presented in forest plots. Sensitivity analyses were conducted to identify possible differences in risk estimates across surveys. Information on risk factors for violence was extracted if replicated in more than one study. Nine studies were identified that compared the risk of violence in epilepsy or traumatic brain injury compared with unaffected controls. For the epilepsy studies, the overall pooled odds ratio for violent outcomes was 0.67 [95% confidence interval (CI) 0.46-0.96]. For traumatic brain injury, the odds ratio was 1.66 (95% CI 1.12-2.31). An additional 11 case-control studies investigated factors associated with violence in epilepsy and traumatic brain injury. It was not possible to meta-analyze these data. Comorbid psychopathology was associated with violence. Data on other neurological conditions was limited and unreplicated. In conclusion, although the evidence was limited and methodological quality varied, epilepsy and traumatic brain injury appeared to differ in their risk of violence compared with control populations. Longitudinal studies are required to replicate this review's provisional findings that epilepsy is inversely associated with violence and that brain injury modestly increases the risk, and further research is needed to provide information on a broader range of risk factors.
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| 7. |
- Fazel, S., et al.
(författare)
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Reply to comments by Mr. Carlin and Mr. Hardisty
- 2008
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Ingår i: Journal of Clinical Psychopharmacology. - 0271-0749. ; 28:4, s. 477-
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Tidskriftsartikel (refereegranskat)abstract
- Reply by the current authors to the comments made by Carlin and Hardisty on the original article. Carlin and Hardisty question whether, in our postmortem study of 14,691 suicides in Sweden during 1992-2004, the methodology was sensitive enough to allow any conclusions. In addition, they question our disclosure of funding and consultancy arrangement. There was no funding for the study. Author disclosure information was submitted with the paper. It was the Journal's decision not to publish it because it was deemed not relevant to the study or paper.
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| 8. |
- Fazel, Seena, et al.
(författare)
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Risk Factors for Violent Crime in Schizophrenia : A National Cohort Study of 13,806 Patients
- 2009
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Ingår i: Journal of Clinical Psychiatry. - 0160-6689 .- 1555-2101. ; 70:3, s. 362-369
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To determine risk factors for and prevalence of violent crime in patients with schizophrenia, and in particular, to explore the contribution of familial risk factors. Method: We designed a cohort study that followed up patients with 2 or more hospitalizations for schizophrenia (ICD-8, ICD-9, and ICD-10 criteria) and investigated the risk for a violent conviction using Cox proportional hazards models. All 13,806 patients with 2 hospital discharge diagnoses of schizophrenia from January 1, 1973. through December 31, 2004, in Sweden were followed until violent conviction, emigration, death, or end of follow-up (December 31, 2004), and associations with sociodemographic, individual (substance abuse comorbidity, and previous violence), and familial (parental violent crime and parental alcohol abuse) factors were examined. Results: Over an average follow-up period of 12 years, 17.1% (N = 15 19) of the men and 5.6% (N = 273) of the women with 2 or more hospitalizations for schizophrenia had a violent conviction after discharge from hospital. Familial risk factors had moderate effects, increasing the risk for violent convictions by 50% to 150%. After adjustment for sociodemographic and individual risk factors, the associations between parental violent crime and risk of violent convictions remained in men (adjusted hazard ratio [HR] = 1.65, 95% Cl = 1.33 to 2.04) and in women (adjusted HR = 1.83. 95% CI = 1.11 to 3.01), whereas parental alcohol abuse was no longer significantly associated with violent crime. Conclusion: Parental violent crime had moderate associations with violent crime in male and female offspring with at least 2 hospitalizations for schizophrenia, which were mostly stronger than the better documented sociodemographic risk factors. This suggests that familial (genetic or early environmental) risk factors have an important role in the etiology of violent offending among individuals with schizophrenia and should be considered in violence risk assessment.
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| 9. |
- Fazel, Seena, et al.
(författare)
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Schizophrenia, substance abuse, and violent crime
- 2009
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Ingår i: Journal of the American Medical Association (JAMA). - : American Medical Association (AMA). - 0098-7484 .- 1538-3598. ; 301:19, s. 2016-2023
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Tidskriftsartikel (refereegranskat)abstract
- CONTEXT: Persons with schizophrenia are thought to be at increased risk of committing violent crime 4 to 6 times the level of general population individuals without this disorder. However, risk estimates vary substantially across studies, and considerable uncertainty exists as to what mediates this elevated risk. Despite this uncertainty, current guidelines recommend that violence risk assessment should be conducted for all patients with schizophrenia. OBJECTIVE: To determine the risk of violent crime among patients diagnosed as having schizophrenia and the role of substance abuse in mediating this risk. DESIGN, SETTING, AND PARTICIPANTS: Longitudinal designs were used to link data from nationwide Swedish registers of hospital admissions and criminal convictions in 1973-2006. Risk of violent crime in patients after diagnosis of schizophrenia (n = 8003) was compared with that among general population controls (n = 80 025). Potential confounders (age, sex, income, and marital and immigrant status) and mediators (substance abuse comorbidity) were measured at baseline. To study familial confounding, we also investigated risk of violence among unaffected siblings (n = 8123) of patients with schizophrenia. Information on treatment was not available. MAIN OUTCOME MEASURE: Violent crime (any criminal conviction for homicide, assault, robbery, arson, any sexual offense, illegal threats, or intimidation). RESULTS: In patients with schizophrenia, 1054 (13.2%) had at least 1 violent offense compared with 4276 (5.3%) of general population controls (adjusted odds ratio [OR], 2.0; 95% confidence interval [CI], 1.8-2.2). The risk was mostly confined to patients with substance abuse comorbidity (of whom 27.6% committed an offense), yielding an increased risk of violent crime among such patients (adjusted OR, 4.4; 95% CI, 3.9-5.0), whereas the risk increase was small in schizophrenia patients without substance abuse comorbidity (8.5% of whom had at least 1 violent offense; adjusted OR, 1.2; 95% CI, 1.1-1.4; P<.001 for interaction). The risk increase among those with substance abuse comorbidity was significantly less pronounced when unaffected siblings were used as controls (28.3% of those with schizophrenia had a violent offense compared with 17.9% of their unaffected siblings; adjusted OR, 1.8; 95% CI, 1.4-2.4; P<.001 for interaction), suggesting significant familial (genetic or early environmental) confounding of the association between schizophrenia and violence. CONCLUSIONS: Schizophrenia was associated with an increased risk of violent crime in this longitudinal study. This association was attenuated by adjustment for substance abuse, suggesting a mediating effect. The role of risk assessment, management, and treatment in individuals with comorbidity needs further examination.
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| 10. |
- Fazel, Seena, et al.
(författare)
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Sexual Offending in Women and Psychiatric Disorder : A National Case-Control Study
- 2010
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Ingår i: Archives of Sexual Behavior. - : Springer Science and Business Media LLC. - 0004-0002 .- 1573-2800. ; 39:1, s. 161-167
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Tidskriftsartikel (refereegranskat)abstract
- Women commit 4-5% of all sexual crimes, but there is considerable uncertainty about associations with psychosis and substance abuse. We examined the prevalence of psychiatric hospitalization, psychotic disorders, and substance abuse in a nationwide sample of female sexual offenders. We obtained data from Swedish national registers for criminal convictions, hospital discharge diagnoses, and demographic and socioeconomic factors between 1988 and 2000, and merged them using unique identifiers. Convicted female sexual offenders (n = 93) were compared with all females convicted of non-sexual violent offences (n = 13,452) and a random sample of general population women (n = 20,597). Over 13 years, 36.6% of female sexual offenders had been admitted to psychiatric hospital and 7.5% been discharged with a diagnosis of a psychotic disorder. Compared to non-sexual violent offenders, there were no significant differences in the proportion diagnosed with psychosis or substance abuse. Compared to women in the general population, however, there was a significantly increased risk in sex offenders of psychiatric hospitalization (age-adjusted odds ratio [AOR] = 15.4; 95% CI: 10.0-23.7), being diagnosed with a psychotic disorder (AOR = 16.2; 95% CI: 7.2-36.4), and with substance use disorders (AOR = 22.6; 95% CI: 13.0-39.1). We conclude that the prevalence of psychotic and substance use disorders was not different between sexual offenders and other violent offenders, suggesting non-specificity of sexual offending in women. Nevertheless, substantially increased prevalences of psychiatric disorder, underline the importance of screening and assessment of female sexual and other violent offenders.
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| 11. |
- Fazel, Seena, et al.
(författare)
-
"Suicides by violent means in individuals taking SSRIs and other antidepressants: A postmortem study in Sweden, 1992-2004" : Erratum
- 2008
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Ingår i: Journal of Clinical Psychopharmacology. - 0271-0749. ; 28:1, s. 123-
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Tidskriftsartikel (refereegranskat)abstract
- Reports an error in "Suicides by violent means in individuals taking SSRIs and other antidepressants: A postmortem study in Sweden, 1992-2004" by Seena Fazel, Martin Grann, Johan Ahlner and Guy Goodwin (Journal of Clinical Psychopharmacology, 2007[Oct], Vol 27[5], 503-506). In the article, the entire second to the last sentence in the abstract on page 503 should have been deleted. (The following abstract of the original article appeared in record 2007-14520-014). A number of reports have linked consumption of selective serotonin reuptake inhibitors (SSRIs) with suicide by violent methods. We aimed to determine whether suicides with postmortem evidence of SSRI consumption are more likely to have used violent methods compared with suicides with no detectable antidepressants. Blood samples from all suicides in Sweden during 1992-2004 were examined. Suicides were classified into those who died by violence and nonviolent (self-poisoning) methods using information from police records and autopsy. In addition, we investigated proportions of violent suicide in individuals who died with detectable levels of tricyclic and other antidepressants. The sample consisted of 14,691 suicides. Of the 1958 suicides with detectable levels of SSRIs, 1247 were by violent means (63.7%) compared with 7835 of 11,045 suicides (70.9%) in antidepressant-free group (χ◊-sub-1 = 7.6; P < 0.01). We found no significant differences in the proportion of violent suicides in the SSRI group compared with the antidepressant-free group by sex or age band (15-24, 25-39, and over 40 years). When subdivided by gender and age-bands, we found specific groups with significantly lower proportions of violent suicides compared with the antidepressants-free group, including men aged 15-24 years.
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| 12. |
- Grann, Martin
(författare)
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Personality disorder and violent criminality : a follow-up study with special reference to psychopathy and risk assessment
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Structured models for the assessment of psychopathy and risk of violent recidivism have gained currency in forensic and correctional practice in many countries. The overall aim of this study was to test the predictive validity of some of these models among violent offenders with personality disorders in Sweden. Method: The study was a retrospective follow-up of all offender convicted of a violent crime and subjected to a forensic psychiatric evaluation during 1988 - 90 diagnosed with a personality disorder with or without concomitant substance disorder (N=401). Data on background, clinical and crime characteristics as well as recidivism during follow-up were obtained from archives and registers. Predictive validity was estimated with receiver operating characteristic (ROC) analysis. Results: In accordance with the current Swedish legislation, the vast majority of offenders with PDs are sentenced to prison instead of treatment (Paper I. Methodological pre-studies on the archive and register material yielded a set of historical, crime-related, and clinical variables that could be reliably extracted for research purposes (Papers II-III), including psychopathy according to Hare's Psychopathy Checklist - Revised (PCL-R). Psychopathy was found to be clearly associated with an increased risk of violent recidivism, and was demonstrated to have a moderate, statistically significant predictive validity (Paper IV). This was also the case with two actuarial risk assessment instruments; the Violence Risk Appraisal Guide (VRAG) and the historical part of the so-called HCR-20. In terms of ROC-curves, these instruments discriminated between recidivists and non-recidivists with areas under curves of .68 and .71 (Paper V). The largest ROC-area (.81) was found in a study in which the risk for recidivism was modeled with an artificial neural network (Paper IV). Conclusions: The results of this study suggest that these models exhibit a clear, albeit moderate, predictive validity in the Swedish context as well. Future research may benefit from prospective study design, inclusion of other offender groups, and broader outcome measures.
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| 13. |
- Grann, Martin, et al.
(författare)
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Psychopathy (PCL-R) predicts violent recidivism among criminal offenders with personality disorders in Sweden
- 1999
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Ingår i: Law and human behavior. - : American Psychological Association (APA). - 0147-7307 .- 1573-661X. ; 23:2, s. 205-217
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Tidskriftsartikel (refereegranskat)abstract
- Psychopathy as conceptualized with Hare's Psychopathy Checklist Revised, PCL-R, has attracted much research during the 1990s. In the Scandinavian countries, few studies that empirically support the validity of North American risk assessment techniques in our regional context have been published. The purpose of this paper is to explore the predictive power of the PCL-R in a population of personality-disordered violent offenders subjected to forensic psychiatric evaluation in Sweden. Following release from prison (n = 172), discharge from forensic psychiatric treatment (n = 129), or probation (n = 51), a total of 352 individuals were followed for up to 8 years (mean = 3.7 years) with reconviction for violent crime as endpoint variable (base rate 34%). As the estimate of predictive power, the area under the curve of a receiver operating characteristic (AUC of ROC) analysis was calculated. For PCL-R scores to predict 2-year violent recidivism, AUC of ROC was .72 (95% CI: .66-.78). In addition, the personality dimension of psychopathy (Factor 1) and the behavioral component (Factor 2) both predicted 2-year recidivism significantly better than random: AUC of ROC .64 (95% CI: .57-.70) and .71 (95% CI: .65-.77), respectively. We conclude that psychopathy is probably as valid a predictor of violent recidivism in Swedish forensic settings as seen in previous North American studies.
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| 14. |
- Grann, Martin, et al.
(författare)
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The association between psychiatric diagnosis and violent re-offending in adult offenders in the community
- 2008
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Ingår i: BMC Psychiatry. - 1471-244X. ; 8, s. 92-
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Tidskriftsartikel (refereegranskat)abstract
- Background: High rates of repeat offending are common across nations that are socially and culturally different. Although psychiatric disorders are believed to be risk factors for violent reoffending, the available evidence is sparse and liable to bias. Method: We conducted a historical cohort study in Sweden of a selected sample of 4828 offenders given community sentences who were assessed by a psychiatrist during 1988-2001, and followed up for an average of 5 years for first violent offence, death, or emigration, using information from national registers. Hazard ratios for violent offending were calculated by Cox regression models. Results: Nearly a third of the sample (n = 1506 or 31.3%) offended violently during follow-up (mean duration: 4.8 years). After adjustment for socio-demographic and criminal history variables, substance use disorders (hazard ratio 1.97, 95% CI, 1.40-2.77) and personality disorders (hazard ratio 1.71, 1.20-2.44) were significantly associated with an increased risk of violent offending. No other diagnoses were related to recidivism risk. Adding information on diagnoses of substance use and personality disorders to data recorded on age, sex, and criminal history improved only minimally the prediction of violent offending. Conclusion: Diagnoses of substance use and personality disorders are associated with the risk of subsequent violent offending in community offenders about as strongly as are its better documented demographic and criminal history risk factors. Despite this, assessment of such disorders in addition to demographic and criminal history factors enhances only minimally the prediction of violent offending in the community.
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| 15. |
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| 16. |
- Jones, Roland M., et al.
(författare)
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Alcohol Use Disorders in Schizophrenia : A National Cohort Study of 12,653 Patients
- 2011
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Ingår i: Journal of Clinical Psychiatry. - 0160-6689 .- 1555-2101. ; 72:6, s. 775-779
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Tidskriftsartikel (refereegranskat)abstract
- Background: Comorbid alcohol use disorders (AUDs) in schizophrenia are associated with increased morbidity, more inpatient treatment, and violent offending. It is of clinical importance to identify those with schizophrenia who may go on to develop an alcohol use disorder; however, the risk factors are not well understood. The aim of this study was to identify risk factors for the development of an AUD in patients after they had been diagnosed with schizophrenia. Method: We conducted a retrospective case-control study of 12,653 individuals diagnosed with ICD-defined schizophrenia in Sweden in 1973-2004, using data from national registers. We tested the associations between individual factors (marital status, immigrant status, and previous violent offending), sociodemographic factors (income and education), and parental risk factors (AUDs, psychosis, and violent offending) ICD-defined and AUD development using logistic regression modeling. Results: Over a median follow-up of 17.3 years, 7.6% of patients had at least 1 hospital diagnosis of AUD. After adjustment for gender and age at diagnosis in a multivariate regression model, previous violent offending (OR=2.1; 95% CI, 1.8-2.5), low education (OR=1.3; 95% CI, 1.1-1.5), maternal AUD (OR=1.9; 95% CI, 1.4-2.7), and paternal AUD (OR=1.9; 95% CI, 1.5-2.3) remained independently associated with increased risk of patient AUD. Conclusions: AUDs are a common sequela of schizophrenia. Risk factors that could be identified at the time of first presentation include low educational attainment, previous violent offending, and parental history of AUDs and may inform clinical treatment and follow-up of those most at risk.
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| 17. |
- Kullgren, Gunnar, et al.
(författare)
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Suicide among personality-disordered offenders : a follow-up study of 1943 male criminal offenders.
- 1998
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Ingår i: Social Psychiatry and Psychiatric Epidemiology. - : Springer Science and Business Media LLC. - 0933-7954 .- 1433-9285. ; 33 Suppl 1, s. S102-6
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Tidskriftsartikel (refereegranskat)abstract
- Suicide mortality among all male criminal offenders in Sweden who had been subjected to a major forensic psychiatric examination 1988-1991 (n = 1943) was studied, with special reference to offenders with personality disorders. The cohort was followed until the end of 1995. Altogether 135 individuals (6.9%) died during the follow-up period; the mode of death was suicide in 50 individuals (2.6%). The unadjusted suicide mortality ranged from 2.8% among those with personality disorders to 6.1% among those with drug-related psychosis. The standardised mortality ratio (SMR) among personality-disordered offenders was 1212, i.e. around 12 times that of the general population. Survival analyses by means of Cox regression models were performed to identify background factors associated with completed suicide. No specific principal diagnosis showed significantly increased risk for completed suicide. However, concomitant depression and drug abuse were significantly linked to suicide. Violent crime showed no association. Among personality-disordered offenders suicide methods did not differ from those of suicide victims in the general population. There was no association between violent index criminality or between life-time violent criminality and choice of a violent suicide method.
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| 18. |
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| 19. |
- Larsson, Henrik, et al.
(författare)
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A common genetic factor explains the association between psychopathic personality and antisocial behavior
- 2007
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Ingår i: Psychological Medicine. - 0033-2917 .- 1469-8978. ; 37:1, s. 15-26
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Tidskriftsartikel (refereegranskat)abstract
- Background: Both psychopathic personality traits and antisocial behavior are influenced by geneticas well as environmental factors. However, little is known about how genetic and environmental factors contribute to the associations between the psychopathic personality traits and antisocial behavior.Method: Data were drawn from a longitudinal population-based twin sample including all 1480 twin pairs born in Sweden between May 1985 and December 1986. The twins responded to mailed self-report questionnaires at two occasions: 1999 (twins 13–14 years old), and 2002 (twins 16–17years old).Results: A common genetic factor loaded substantially on both psychopathic personality traits and antisocial behavior, whereas a common shared environmental factor loaded exclusively on antisocial behavior.Conclusions: The genetic overlap between psychopathic personality traits and antisocial behavior may reflect a genetic vulnerability to externalizing psychopathology. The finding of shared environmental influences only in antisocial behavior suggests an etiological distinction between psychopathic personality dimensions and antisocial behavior. Knowledge about temperamental correlates to antisocial behavior is important for identification of susceptibility genes, as well as for possible prevention through identification of at-risk children early in life
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| 20. |
- Lindstedt, Helena, et al.
(författare)
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Mentally disordered offenders’ daily occupations after one year of forensic care
- 2011
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Ingår i: Scandinavian Journal of Occupational Therapy. - : Informa UK Limited. - 1103-8128 .- 1651-2014. ; 18:4, s. 302-311
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Tidskriftsartikel (refereegranskat)abstract
- Persons detained as mentally disordered offenders need support for transition from care to community life. Few systematic studies have been completed on the outcomes of standard forensic care. The aim was to investigate the target group's life conditions and daily occupations one year after care. In a follow-up design occupational performance (OP) and social participation (SP) were investigated at two time points. After informed consent 36 consecutively recruited participants reported OP using the Capability to Perform Daily Occupations, Self-Efficacy Scale, Importance scale, and Allen Cognitive Level Screen. SP was measured with the Manchester Short Assessment of Quality of Life, and Interview Schedule for Social Interaction. After one year 24 participants were still incarcerated, 11 were conditionally released, and one participant was discharged. The group were generally more satisfied and engaged in daily occupations than at admission. The study's attrition rate, 51%, is discussed. The conclusion and the clinical implications indicate that the target group need early, goal directed interventions in OP and SP for alterations in daily occupations. Furthermore, to increase the knowledge base concerning mentally disordered offenders, studies with research designs that have the potential to uncover changes in daily occupation and other measures for this target group are necessary.
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| 21. |
- Långström, Niklas, et al.
(författare)
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Risk factors for violent offending in autism spectrum disorder : a national study of hospitalized individuals.
- 2009
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Ingår i: Journal of Interpersonal Violence. - : SAGE Publications. - 0886-2605 .- 1552-6518. ; 24:8, s. 1358-70
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Tidskriftsartikel (refereegranskat)abstract
- Little is known about risk factors for violence among individuals with autism spectrum disorder (ASD). This study uses data from Swedish longitudinal registers for all 422 individuals hospitalized with autistic disorder or Asperger syndrome during 1988-2000 and compares those committing violent or sexual offenses with those who did not. Thirty-one individuals with ASD (7%) were convicted of violent nonsexual crimes and two of sexual offenses. Violent individuals with ASD are more often male and diagnosed with Asperger syndrome rather than autistic disorder. Furthermore, comorbid psychotic and substance use disorders are associated with violent offending. We conclude that violent offending in ASD is related to similar co-occurring psychopathology as previously found among violent individuals without ASD. Although this study does not answer whether ASDs are associated with increased risk of violent offending compared with the general population, careful risk assessment and management may be indicated for some individuals with Asperger syndrome.
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| 22. |
- Ottosson, Hans, et al.
(författare)
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Cross-system concordance of personality disorder diagnoses of DSM-IV and diagnostic criteria for research of ICD-10.
- 2002
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Ingår i: Journal of personality disorders. - : Guilford Publications. - 0885-579X. ; 16, s. 283-
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Tidskriftsartikel (refereegranskat)abstract
- The aim in this study was to examine the cross-system concordance between the personality disorders (PDs) of DSM-IV and Diagnostic Criteria for Research of ICD-10 Classification of Mental and Behavioral Disorders, 10th rev. (ICD-10) PD diagnoses were made by a structured interview in a clinical psychiatric sample of 138 individuals. Both categorical and dimensional scores for each PD were established. The frequency of patients with a PD diagnosis on either classification who were also positive on the other varied from 26% for the schizoid PDs to 88% for the histrionic PDs. The chance-corrected agreement (Cohen's kappa) ranged from .37 to .94. The dimensional correlation (Pearson's r) between pairs of PD criteria sets was in the range of .79 to .98. In conclusion, when analyzed categorically, some of the PDs of DSM-IV and ICD-10-DCR were only moderately concordant. The reasons appear to be different criteria formulations and arbitrary thresholds for diagnoses. In contrast to categorical diagnoses, dimensional agreement was high, implicating similar trait-concept definitions. The least concordant pair of PD was antisocial (DSM-IV)-dissocial (ICD-10).
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| 23. |
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| 24. |
- Tengström, Anders, et al.
(författare)
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Psychopathy (PCL-R) as a predictor of violent recidivism among criminal offenders with schizophrenia.
- 2000
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Ingår i: Law and human behavior. - : American Psychological Association (APA). - 0147-7307 .- 1573-661X. ; 24:1, s. 45-58
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Tidskriftsartikel (refereegranskat)abstract
- Hare's Psychopathy Checklist--Revised (PCL-R) was used to test the hypothesis that psychopathy predicts violent recidivism in a cohort subjected to forensic psychiatric investigation and consisting of male violent offenders with schizophrenia (N = 202). Psychopathy was assessed with retrospective file-based ratings. Mean follow-up time after detainment was 51 months. Twenty-two percent of the offenders had a PCL-R score > or = 26 (cutoff), and the base rate for violent recidivism (reconvictions) during follow-up was 21%. Survival analysis revealed that psychopathy was strongly associated to violent recidivism (log-rank = 17.71, df = 1, p < 0.0001). The area under the curve (AUC) of the receiver operating characteristics (ROC) of PCL-R total score to predict violent recidivism varied between different time frames from .64 to .75. Cox regression analyses revealed that other potential risk factors could not equally well or better explain violent recidivism in the cohort than psychopathy as measured by PCL-R.
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| 25. |
- Tengström, Anders, et al.
(författare)
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Schizophrenia and criminal offending : the role of psychopathy and substance use disorders
- 2004
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Ingår i: Criminal justice and behavior. - Thousand Oaks : Sage Publications. - 0093-8548 .- 1552-3594. ; 31:4, s. 367-391
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Tidskriftsartikel (refereegranskat)abstract
- This study investigated the associations of psychopathy and substance use disorders (SUDs) with criminal offending among 202 men with schizophrenia and 78 men with a primary diagnosis of psychopathy. Comparisons among six groups of offenders indicated that non-mentally ill offenders diagnosed with psychopathy committed the highest numbers of offenses per year at risk. Among offenders with schizophrenia, those with high psychopathy scores committed more crimes than those with low psychopathy scores. Among non-mentally ill offenders with psychopathy and schizophrenic offenders with high psychopathy scores, those with and without SUDs committed, on average, similar numbers of offenses. These findings Suggest that among offenders with psychopathic traits, the traits, not substance abuse, are associated with criminal offending.
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| 26. |
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| 27. |
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| 28. |
- Tuvblad, Catherine, 1968-, et al.
(författare)
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Heritability for adolescent antisocial behavior differs with socioeconomic status : gene–environment interaction
- 2006
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Ingår i: Journal of Child Psychology and Psychiatry. - : Wiley. - 0021-9630 .- 1469-7610. ; 47:7, s. 734-743
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Tidskriftsartikel (refereegranskat)abstract
- Background: Socioeconomic status is often assumed to be of importance for the development of antisocial behavior, yet it explains only a fraction of the variance. One explanation for this paradox could be that socioeconomic status moderates the influence of genetic and environmental effects on antisocial behavior.Method: TCHAD is a Swedis h longitudinal population-based twin study that contains 1,480 twin pairs born 1985-1986. The present study included 1,133 twin pairs, aged 16-17 years. Antisocial behavior was measured through self-report. Family socioeconomic status was assessed by parentalreported education and occupational status. Neighborhood socioeconomic conditions were assessed using five aggregated level variables: ethnic diversity, basic educational level, unemployment level, buying power, and crime-rate. We used structural equation modeling to test whether socioeconomic status interacted with latent genetic and environmental effects for antisocial behavior.Results: Gen etic influences on antisocial behavior were more important in adolescents in socioeconomically more advantaged environments, whereas the shared environment was higher in adolescents in socioeconomically less advantaged environments. Heritability for antisocial behavior was higher in girls than in boys, irrespective of socioeconomic background.Conclusions: Our results suggest that differe nt intervention policies should be considered in different socioeconomic areas. In socioeconomically advantaged areas, it might be more fruitful to focus on individually based preventions and treatments. In socioeconomically disadvantaged areas, intervention and prevention policies might be more effective on a community level, to account for shared environmental risk factors.
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| 29. |
- Tuvblad, Catherine, 1968-, et al.
(författare)
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Low heritability for antisocial behavior among adolescents residing in low socioeconomic environments
- 2004
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Ingår i: Behavior Genetics. - 0001-8244. ; 34:6, s. 662-662
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Socioeconomic status and contextual variables are often assumed to be of importance for the development of antisocial behavior (ASB), yet they explain only a fraction of the variance (M. Stouthamer-Loeber,et al.(2002).J. Consult. Clin. Psych.70:111–123; R. J. Sampson, et al.(1997).Science277: 918–924). An explanation to this paradox could be that socioeconomic status moderates the influences of genetic and environmental effects on ASB. The Twin study of CHild and Adolescent Development (TCHAD) is a Swedish longitudinal population-based study including 1,480 twin pairs born 1985–1986.The present study included 1139 of the twin pairs, aged 16–17 years. ASB was measured through self-report. Neighborhood socioeconomic status was assessed using five variables on aggregated level: ethnicity, educational level, occupational status, buying power, and neighbourhood crime rate. Family socioeconomic status was assessed by parental reported educational and occupational status. We used structural equation modeling to test whether socioeconomic status interacts with latent genetic and environmental effects of ASB. We found an interaction for girls between genetic influences and ethnicity; among girls living in a neighborhood with a mixed ethnic population, there was little evidence of genetic effects on ASB, whereas heritability was pronounced in areas with a high degree of ethnic Swedes. For boys, there was an interaction in parental reported occupational status; i.e. low familial occupational status resulted in less influence of genetic effects on ASB. The results suggest that adolescents residing in low socioeconomic environments are less sensitive to genetic influences for ASB.
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| 30. |
- Tuvblad, Catherine, 1968-, et al.
(författare)
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Pubertal timing and antisocial behavior in early and late adolescence : a longitudinal twin study
- 2005
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Ingår i: Behavior Genetics. - : Springer Science and Business Media LLC. - 0001-8244 .- 1573-3297. ; 35:6, s. 823-823
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this study was to examine stability and change in antisocial behavior (ASB) between early and late adolescence and evaluate its association with individual differences in pubertal timing. The Twin study of Child and Adolescent Development (TCHAD) is a Swedish prospective population-based study of 1,480 twin pairs born 1985–1986. The present study included 1,212 twin pairs. Pubertal timing at age 13–14 and ASB at ages 13–14 and 16–17 were measured through self–report. Trivariate Cholesky decomposition was used to analyze the data. For boys and girls, the correlations between pubertal timing in early adolescence and ASB in early and in late adolescence ranged from 0.09 to 0.17 and were to a large extent explained by genetic factors (80–97%). The associations between ASB in early and late adolescence (boys:r= 0.55; girls r= 0.53) were mainly due to genetic (boys: 41%; girls: 59%) and shared environmental factors (boys: 53%; girls: 27%). For boys, unique effects in ASB in late adolescence were due to shared (35%) and non-shared environmental factors (65%), whereas for girls genetic factors were the largest new contributor (56%), with the shared environment accounting for 11%. Early pubertal maturation is a genetic risk factor for ASB. Further, genetic and shared environmental effects were important for continuity in ASB. The genetic influence on continuity suggests that persistence of ASB may mediate genetic effects into adult psychopathology. For boys, only environmental effects contributed to change in ASB at age 16–17, suggesting that boys may be more vulnerable to psychosocial or environmental risk factors (e.g. family discord, delinquent peers). In contrast, for girls, new effects were to large extent explained by genetic factors, indicating that partly different genes are important for ASB in early versus late adolescence.
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| 31. |
- Tuvblad, Catherine, 1968-, et al.
(författare)
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The Genetic and Environmental Etiology of Antisocial Behavior from Childhood to Emerging Adulthood
- 2011
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Ingår i: Behavior Genetics. - : Springer Science and Business Media LLC. - 0001-8244 .- 1573-3297. ; 41:5, s. 629-640
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Tidskriftsartikel (refereegranskat)abstract
- Previous research suggests that both genetic and environmental influences are important for antisocial behavior across the life span, even though the prevalence and incidence of antisocial behavior varies considerably across ages. However, little is known of how genetic and environmental effects influence the development of antisocial behavior. A total of 2,600 male and female twins from the population-based Swedish Twin Registry were included in the present study. Antisocial behavior was measured on four occasions, when twins were 8-9, 13-14, 16-17, and 19-20 years old. Longitudinal analyses of the data were conducted using structural equation modeling. The stability of antisocial behavior over time was explained by a common latent persistent antisocial behavior factor. A common genetic influence accounted for 67% of the total variance in this latent factor, the shared environment explained 26%, and the remaining 7% was due to the non-shared environment. Significant age-specific shared environmental factors were found at ages 13-14 years, suggesting that common experiences (e.g., peers) are important for antisocial behavior at this age. Results from this study show that genetic as well as shared environmental influences are important in antisocial behavior that persists from childhood to emerging adulthood.
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| 32. |
- Walters, Glenn D., et al.
(författare)
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Incremental validity of the Psychopathy Checklist facet scores : Predicting release outcome in six samples
- 2008
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Ingår i: Journal of Abnormal Psychology. - 0021-843X .- 1939-1846. ; 117:2, s. 396-405
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Tidskriftsartikel (refereegranskat)abstract
- The incremental validity of the 4 facet scores (Interpersonal, Affective, Lifestyle, Antisocial) of the Psychopathy Checklist-Revised (PCL-R; R. D. Hare, 1991, 2003) and the Psychopathy Checklist: Screening Version (PCL:SV; S. D. Hart, D. N. Cox, & R. D. Hare, 1995) was evaluated in 6 forensic/correctional samples with average follow-ups ranging from 20 weeks to 10 years. Results indicated that whereas Facet 4 (Antisocial) achieved incremental validity relative to the first 3 facets (Interpersonal, Affective, and Lifestyle) in predicting recidivism in all 6 samples, a block of the first 3 facets achieved incremental validity relative to the 4th facet in only 1 sample. Thus, although there was consistent support for the incremental validity of Facet 4 above and beyond the first 3 facets, there was minimal support for the incremental validity of Facets 1, 2, and 3 above and beyond Facet 4. The implications of these findings for the psychopathy construct in general and the PCL-R/SV in particular are discussed.
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| 33. |
- Yourstone, Jenny, et al.
(författare)
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Evidence of gender bias in legal insanity evaluations : A case vignette study of clinicians, judges, and students
- 2008
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 62:4, s. 273-278
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Tidskriftsartikel (refereegranskat)abstract
- Forensic psychiatric decision-making plays a key role in the legal process of homicide cases. Research show that women defendants have a higher likelihood of being declared legally insane and being diverted to hospital. This study attempted to explore if this gender difference is explained by biases in the forensic psychiatric assessments. Participants were 45 practicing forensic psychiatric clinicians, 46 chief judges and 80 psychology students. Participants received a written vignette describing a homicide case, with either a female or a male perpetrator. The results suggested strong gender effects on legal insanity judgements. Forensic psychiatric clinicians and psychology students assessed the case information as more indicative of legal insanity if the perpetrator was a woman than a man. Judges assessed offenders of their own gender, as they were more likely to be declared legally insane than a perpetrator of the opposite gender. Implications of and possible ways to minimize such gender biases in forensic psychiatric evaluations need to be thoroughly considered by the legal system.
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| 34. |
- Yourstone, Jenny, 1965-
(författare)
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Violent female offenders : Facts and preconceptions
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Women’s comparably low participation in criminal activity has resulted in little overall attention to female offenders in criminological research. The general aim of the present thesis is to illuminate aspects of particular significance for understanding female perpetrators of very serious crimes. Areas of interest are gender differences in the offenders’ psychosocial background, the offenders’ mental illness and medico-legal insanity decisions regarding violent offenders. Study I compared the psychosocial background of female and male perpetrators convicted of homicide in Sweden. The female perpetrators had experienced more severe childhood circumstances. At the time of the crime they had a more ordered social situation but they were more likely to have been exposed to violence and to have sought help than the corresponding men. Study II investigated differences between female and male offenders regarding forensic psychiatric diagnoses and medico-legal insanity decisions. A significantly higher proportion of mentally disordered females were diagnosed with personality disorder, while mentally disordered male offenders more often received a diagnosis of substance dependence or sexual disorders. There was an increased likelihood for violent women to be declared legally insane. Study III attempted to explore whether the differences observed in Study II could be explained by gender bias in forensic psychiatric assessments. The results suggested strong gender effects on legal insanity judgments among clinicians and judges. Consequently, the higher occurrence of legal insanity decisions regarding female defendants found in Study II could be explained, at least in part, by gender-related bias in the judicial system. Influence from such legally irrelevant factors may pose a serious threat to the fairness of the legal system. These results highlight the need for increased knowledge and awareness of human information processing limitations among legal decision-makers.
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