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- Dåderman, Anna Maria, 1953-
(författare)
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“Dr Jekyll and Mr Hyde?” : Abuse of potent benzodiazepines, exemplified by flunitrazepam, in mentally disordered male offenders
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Flunitrazepam (FZ) is an example of a sedative-hypnotic benzodiazepine whose pharmacokinetic properties include a rapid onset of action and an intermediate duration of action. It has a high affinity to central benzodiazepine receptors and affects them profoundly. These properties, and its profile of activity, increase the probability of abuse by those who have access to it. Known side effects of FZ are abuse and amnesia. FZ is widely abused and it has become a drug of choice among opioid abusers, as a club drug, and as a classic “date-rape” drug. FZ is often involved in fatal intoxication. It is therefore expected that FZ abuse is common in serious offenders. I have studied the reasons for FZ abuse and mapped the prevalence of the abuse, with the objective of studying the personalities and the background factors of the abusers, and of drawing some conclusions about assessment procedures of FZ abuse and the position of FZ in society.The participants in the studies summarised here were fifty-six juvenile delinquents from Swedish youth correctional institutions, aged 14-20 years, and sixty non-psychotic male offenders referred for a forensic psychiatric evaluation (FPE), aged 16-35 years. The participants answered questions regarding their abuse, and this enabled us to understand why they abused just FZ (and not another substance). The participants also completed a number of self-reported inventories, which enabled us to obtain measures of personality traits. They were also rated for psychopathy. Five forensic psychiatric cases of FZ abusers were studied in more detail. Furthermore, the forensic psychiatric participants’ psychiatric diagnoses, and both groups’ crime-related measures, were obtained from their files.About 40% of the juvenile delinquents and 30% of the offenders referred for a forensic psychiatric evaluation abused FZ. The main reason for the FZ abuse was to change a perception of reality and to obtain an increased feeling of power and self-esteem, a feeling that everything was possible. Both samples of offenders differed from the normal population in many personality traits, suggesting that the participants possessed a high level of vulnerability for developing mental disorders, but only a few differences in personality traits were found between FZ abusers and non-FZ abusers. The juvenile delinquent FZ abusers had higher scores than non-FZ abusers in the verbal aggression and sensation-seeking boredom susceptibility scales. In the juvenile sample, FZ abuse was associated with the abuse of amphetamines and/or cocaine, cannabis, and opiates, and with childhood psychological/psychiatrical contact, with living in a metropolitan housing area, and with recidivism into crimes leading to care in a juvenile correctional institution. In this sample, FZ abuse was also associated with weapons offences and narcotics-related crimes. In the forensic psychiatric sample, FZ abuse was significantly associated with previous admission to an FPE, and convictions for robbery, for weapons-related offences, for narcotics-related offences and for theft. The results show that FZ is more common in offenders who score high on Facet 4 (Antisocial) in the Hare psychopathy model, and that FZ abuse has high correlation with Item 20 (Criminal versatility). All of the FZ abusers reported side effects from FZ that resulted in the brutality of their violent acts and anterograde amnesia. FZ abusers, when intoxicated with FZ, had a reduced capacity for both empathy and anticipatory anxiety, in contrast to their “daily” behaviour and “ordinary” (i.e., without the influence of the FZ) personality characteristics. They were not characterised by classic characteristics of psychopathy, such as lack of empathy. This may indicate that FZ induces psychopathic-like state-dependant (FZ intoxication) traits, and temporary dissociate states (“Dr Jekyll and Mr Hyde”?).In conclusion, FZ abuse is common in the population of young offenders with mental disorders, and FZ is often used for nonmedical purposes. The practical implications of these conclusions are that clinicians and those who develop or manage therapeutic programs should be aware of FZ abuse when choosing the most effective treatment for male offenders. General practitioners who prescribe potent sedative compounds should be aware of their possible adverse effects. The availability of FZ should be limited further, because FZ is frequently abused in vulnerable male offenders, and because FZ has serious adverse mental health-related effects and is related to robbery and weapons‑related crimes.
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| 2. |
- Dåderman, Anna Maria, 1953-, et al.
(författare)
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Lack of psychopathic character (Rorschach) in forensic psychiatric rapists
- 2008
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 62:3, s. 176-185
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Tidskriftsartikel (refereegranskat)abstract
- Previous research using Rorschach is sparse in rapists. The aim of this study of 10 violent male forensic psychiatric rapists was to describe them on a set of Rorschach variables, which are assumed to reflect psychopathic character, in order to increase our understanding of rapists. The participants were involved in a long-term psychodynamic sexual offender treatment program. They were previously assessed on dyslexia and ADHD, and the results showed an overrepresentation of these disorders in this sample. Compared with normative samples, the participants scored significantly lower on three of the Rorschach variables; Lambda, WSum6 and Afr. The participants did not meet criteria for psychopathic character. Although the generalization of the results from 10 rapists is severely limited, our results suggest helplessness in managing emotionally laden situations and hint at the problems experienced by this sample of forensic psychiatric rapists. Clinicians should be aware of the lack of psychopathic character in some rapists and that effective treatment programs should focus on training this type of rapists to be able to react appropriately to emotional stimuli.
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| 3. |
- Dåderman, Anna Maria, 1953-, et al.
(författare)
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Psychopathic traits and lifestyle in flunitrazepam abusers
- 2005
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- The abuse of flunitrazepam (FZ) compounds is world-wide. We have examined whether any of the four facets of the Psychopathy Checklist-Revised (PCL-R) (Interpersonal, Affective, Lifestyle, and Antisocial) (Hare, 2003) is related to different substance use disorders, with the focus on FZ abuse. Participants were 114 male offenders aged 14-35 years, all of whom were convicted for severe, predominantly violent, offences. Abuse of FZ was more common in offenders who scored high in Facet 4 (Antisocial) of the PCL-R (odds ratio = 4.30, 95% C.I. 1.86 - 9.94). Using all 20 PCL‑R items as individual predictors of being an FZ abuser, only one of the items, Item 20) (Criminal versatility) was significantly associated with FZ abuse (odds ratio = 3.72, 95% C.I. 1.85 - 7.50). We suggest that abuse of FZ is more common in offenders who score high in Facet 4, and that FZ abuse is significantly associated with Item 20. Our results show that clinicians and those who develop or manage therapeutic programs should be aware of FZ abuse when choosing the most effective treatment for young mentally disordered severe offenders.
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