WEEK 1
VINKERS, BEURS (2011)—The relationship between mental disorders and different types of crime
Summary
- The aim of this study was to examine the relationship between types of mental disorders and types of crime in pre-trail defendants.
- They checked the prevalence of axis I disorders (personality disorders, intellectual functioning and substance abuse) in defendants
charged with a range of crimes (homicide, attempted or threatened homicide, assault, battery, rape, sexual crime, arson and
property crime).
- They found:
That arson had the strongest relationship with mental disorder, then assaults then homicidal threats and attempts.
Sexual and property crimes have the weakest relationship with diminished or absent accountability.
Diminished accountability had the strongest relationship with psychotic disorders, followed by developmental disorders,
whereas other axis I disorders, personality disorders or IQ<85 was only moderately related.
Cannabis and hard drugs were significantly associated with decreased accountability only in respect to arson.
- Mental disorders are related to all types of crimes but especially to arson, battery and homicidal attempts
- Patients suffering from mental disorders are more often convicted for crimes than the general population.
- Some research suggest that this is in all kinds of crime and some other suggest that is only relation to violent offences.
- A limitation for this is that most analysis have been done either between one type of disorder and various types of offending or between one
type of offence and various types of disorder. Never several disorders with several kinds of crime.
- Offending is usually broadly categorized, such as violent offending or sexual offending.
- In it noteworthy that the association between the presence of mental disorders and criminal offences do not explain the relationship. For
example, a psychotic disorder mat be relation to violent offences because a psychosis limits the cognitive ability for making rational
choices, but the property crime by a psychotic patient may be cause by the need of money.
- Even though disorder and crime may be related, the underlying mechanisms may differ.
- In the Dutch courts, diminished accountability is considered if there is a clear relationship between mental disorder and crime committed.
- There are 5 degrees for responsibility
1. Completely responsible (committed a crime while fully in his right mind either because of the absence of a mental disorder or
presence of a mental disorder that is not related to the crime)
2. Slightly diminished
3. Diminished
4. Severely diminished
5. Total absence of responsibility (Normally a severe mental disorder of psychotic nature is necessary for this one and this absolves
guilt completely)
- They checked pre trial records between 2000 and 2006. Where there was information on their mental state. Demographic information is
present in these reports, these being: age, gender, history of judicial contact. These were assessed by psychologist, psychiatrist or both
- Mental disorders:
1. ADHD
2. Affective disorders
3. Developmental disorders
4. Organic psychosyndromes
5. Paraphilia, psychotic disorder and others
- Personality disorder (Cluster A, B, C, Not otherwise specified or developing personality disorder)
- Intellectual functioning (above average, average and below average and IQ<85)
- Substance abuse (Alcohol, cannabis or hard drugs)
- Crimes were categorized as the summary mentioned.
Discussion:
All types of mental disorder were related to all types of criminal charge but that some specific crime: disorder relationship could
be identified which were much stronger than others.
The presence of any kind of mental disorder is more strongly associated with arson, battery, homicidal attempts, sexual crimes
and violent crimes.
Psychotic disorder was associated with all kinds of crime except rape.
Developmental disorder most strongly associated with homicide.
Personality disorder especially associated with sexual crime and homicide.
IQ<85 strongly related to sexual crimes
Cannabis and hard drugs only significantly associated with a decreased accountability in arson.
There is a selection bias in this study which leads to overestimation of frequency of mental disorder
LAU, GUNTHER (2019)—Latent class analysis identified phenotypes in individuals with
schizophrenia spectrum disorder who engage in aggressive behaviour towards others
Summary
,- There has been shown an inconsistency in the number of subgroups and the operationalization of the concept of typology of offenders with
schizophrenia spectrum disorder.
- This study addressed the inconsistencies by applying latent class analysis. This identified similarities and differences between the subjects
contained in the sample instead of the variables explored.
- They performed this on 71 variables taken from data on previously unstudied sample of 370 case histories of offenders with SSD in a centre
therapy in Switzerland.
- Results confirmed three separate homogeneous classes of schizophrenic delinquents.
- Evidence shows that both men and woman with schizophrenia spectrum disorder have an elevated risk of being convicted of nonviolent
criminal offences, a higher risk of being convicted of violent offences and an even higher risk of being convicted of homicide.
- However, this is a very heterogeneous group.
- One of the known approaches for trying to cluster this heterogeneity was the work made by Hodgins.
- He created a typology investigating offender patients suffering from severe mental illness (SMI).
1. Early starters
2. Late starters
3. First offenders (Subgroup of late starters)
- This typology has three subgroups. Results on the review of this have been inconsistent.
- Studies have provided evidence for two out of three subgroups of offenders. It distinguished early starters (ES) from late starters (LS)
Early starters: Either committing an offence between the age of 18. Being diagnosed with conduct disorder before the age of 15
or as offending before the first evidence of a severe mental illness.
Late starters: Committing an offence after the age of 18, not being diagnosed with conduct disorder before the age of or
offending after there is already evidence of severe mental disorder being reported.
First offenders: predominantly males in their late 30s with a chronic schizophrenia, but without any prior history of aggressive or
antisocial behaviour. This will typically engage in homicide of those caring for them (people close).
- Early starters are more common in deprived families of individuals that were separated from their biological parents, people that
experienced physical abuse, that perform poorly at school, to have conduct problems, to use alcohol and illegal substances and to commit a
greater variety and number of crimes before being diagnosed with a severe mental disorder.
- There are however some inconsistencies about this and hence this study is trying to solve that. It has four objectives:
1. Whether there are either two or three subgroups of offenders with a schizophrenia spectrum disorder (SSD)
2. And the different operationalizations of Hodgins typology that have been applied.
3. Utilize new methodology
4. And explore different variables
They basically assess the number of subgroups in an unexplored sample of offenders with SSD in Switzerland.
Discussion:
They focused on similarities and differences between classes of offenders with SSD instead of between variables examined.
The study confirms the existence of the three subgroups of offenders
They managed to achieve all their four objectives
There is a major limitation when the parameter for the subgroups is age at either first symptoms, first treatment of diagnosis. First,
offending may delay the treatment of SSD and thus result in the false subgrouping of offender patients.
Second, whether women are analysed separately or together with makes may also have an impact because it is estimated that
woman get diagnosed around the age of 40 which is about six years later than men.
This is a good measure for subgrouping whenever no other variable is available.
VAN DONGEN, BUCK (2015)—Antisocial personality characteristic and psychotic symptoms: Two
pathways associated with offending in schizophrenia
Summary
- Research has shown that people with schizophrenia who offend do not form a homogeneous group, there are the early starters the late
starters and the first offenders, as suggested by Hodgins.
- This study assesses
1. Whether the personality of early starters and non-psychotic offenders would be similar, but different from either late-starters.
2. Whether the late-starters would be more likely to have positive psychotic symptoms than non-criminal patients with schizophrenia and
3. Whether the symptom types would differentiate between psychotic groups.
- They got all kind of subgroups from NIPF in holland and some people with no criminal record in Rotterdam but with the diagnosis
- They found that early starters resembled the non-psychotic offenders in their premorbid anti-social personality characteristics.
- The late offenders were more likely to have persecutory and or grandiose delusions than non-offenders with psychosis, but so were the
early starters.
- There is a significant relationship between psychosis and criminal behaviour. The relationship between schizophrenia and violent crimes is
stronger than the relationship between schizophrenia and non-violent ones.
- Early starters—show antisocial personality characteristics early in life. This may be reflected in childhood history. Delinquent and
criminal behaviour BEFORE the onset of a major mental disorder.
- Late starters—Also called adult starters start offending in adulthood AFTER the onset of a major mental disorder. Criminal behaviour
more attributable o cognitive and perceptual (positive) symptoms of disorders.
- The first offenders—The ones the out of the sudden are in their 30s and commit a violent crime with no prior criminal or aggressive
history. Normally the victim is someone close to them
- In this study they want to test whether relative role of personality and positive symptoms of schizophrenia within one sample of patients
and non-psychotic offenders.
,Findings:
- They measured anti-social personality disorder, substance abuse and positive symptoms.
- It was confirmed that anti-social personality diagnosis or traits, psychopathic traits, disruptive behaviour disorders and substance abuse
disorders other than alcohol were more prevalent in early starters than in non-psychotic offenders, as were conduct problems in youth. More
early starters had anti-social personality characteristics, substance use diagnosis and conduct problems in adolescents.
- Early starters were the first offenders were more likely to use alcohol than early onset offenders.
- Higher percentage of early starters had precursory delusions than non-offenders with psychosis.
- Same was found for late starters and first offenders.
- Offender’s groups with psychosis did not differ from each other in prevalence of positive symptoms.
- Presence of psychotic symptoms pertinent to the offending did not distinguish the groups. This might be because early staters start
offending because of early anti-social personality characteristics and subsequently develop schizophrenia, but the symptoms are co-
incidental to their offending. As an alternative, early starters may start their offending because of antisocial personality characteristics, but
subsequent psychotic symptoms are associated with development of maintenance of the offending.
- It seems likely that in both late onset groups, the offending is associated with positive symptoms of schizophrenia especially delusions but
not with anti-social personality traits.
- The findings are more strongly supportive of the two-pathway model—that there is one that may be associated with delusions but is as or
more strongly associated with anti-social personality characteristics (early onset), and one that is associated more or less purely with
delusional ideation (late onset)
- This study has important implications for treatment, which would have to be differently balanced in assessment and treatment strategies if it
is to accommodate important differences in the needs of offender patients.
DARREL-BERRY (2016)—The relationship between paranoia and aggression in psychosis: a
systematic review
Summary
- Aggression in the context of schizophrenia has a significant detrimental personal, clinical and societal implications.
- This article investigates the relationship between paranoia and aggression in psychosis.
- 9 studies were analysed
- Studies showed a mix support for an association between paranoia and aggression in both inpatients and community settings.
- More methodological rigorous studies, however, showed a positive association.
- The rates of violence are higher in people with a diagnosis of schizophrenia compared to the general population and other psychiatric
disorders.
- While not all people with schizophrenia is violent, the ones who are, are the major contributor to poor treatment outcomes and as such are
detrimental to the well being of those to receive a diagnosis, their families and society.
- Aggression—behaviour that is intended to harm, that is directed at others and which the perpetrator believes the victim would be motivated
to avoid.
- Violence—is aggression that has extreme harm as a goal
- Violence and aggression in people with schizophrenia most often occur during periods of active or untreated psychosis.
- Paranoia inclusive of persecutory delusions, is a common symptom of schizophrenia.
And it represents the unsubstantiated, yet intense and tenacious, believe that one is a
threat of harm or persecution from others. Individuals who have this tend to generate
other-blaming, externalising causal attributions for negative evens and over attribute
threat to ambiguous stimuli.
Findings:
Comparing
aggressive and
non-aggressive
groups
Three
studies
found a
relationship between paranoia and physical aggression.
Those in the aggressive group were more likely to report
persecutory delusions and greater levels of suspiciousness.
Physically aggressive patients were more hostile and
suspicious than non physically aggressive patients. While
persistently aggressive were the ones that showed this the
most.
In one study the aggressive patients were underrepresented
in the sample (11 aggressive and 47 on aggressive)
Correlational studies
6 studies found a positive correlation between paranoia and
aggression.
, Discussion:
There are three big shortcomings in here:
1. Studies are largely heterogenous
2. Studies were based on a diverse range of
aggression and violence measures
3. Studies varied greatly in their
operationalization of aggression
When study quality was taken into account
better quality studies found a positive association between paranoia and aggression. However, studies regarding paranoia and
aggression remain inconclusive
Greater severity of paranoia was associated with increased aggression even when controlling for impulsivity, command
hallucinations, antipsychotic medication, age and gender.
Persistently aggressive inpatients reported higher paranoia scores than in transiently aggressive or non-aggressive patients.
Greater suspiciousness was related to decreased ability to control outwards anger expressions. This shows that anger mediates the
association between severe aggression and delusions of being persecuted or spied on.
There are two potential explanations for the association between paranoia and aggression:
1. Aggression as a safety behaviour
2. Aggression as a retaliatory response.
It is well established that paranoid individuals have an attentional bias for threat cues and to attribute hostile intent to others.
These factors are likely to increase paranoid individuals perception that a threat is present, which they are subsequently likely to
be motivated to eradicate. Paranoid individuals may use aggression as a safety behaviour in an effort to maintain their safety and
prevent threats. Alternatively, responding aggressively to perceived threats may be precipitated by a desire for retribution.
HODGINS, CHECKNITA (Chapter 10)— Antisocial personality disorder
Key points for this chapter:
- Antisocial personality disorder (ASPD) is diagnosed as such in adulthood and conduct disorder (CD) prior to the age of 15.
- ASPD is diagnosed in 5% of men and only 1% of women. In CD is 10% for boys and 4% for girls
- The presentation of ASPD and CD among males and females shows both similarities and differences.
- Almost all adolescents with CD and adults with APD have substance misuse. Plus, a significant proportion of the present anxiety and
depression disorders, and or ADHD. They also experience maltreatment in childhood and physical victimization in adulthood.
- CD and ASPD are associated with increased sensitivity to threat and reactive aggression.
- Both CD and ASPD are heritable disorders. It was found that interactions of variants of common genes with negative and positive
environmental factors modify the risk of CD and ASPD. Environmental factors also alter gene expression through epigenetic mechanisms.
- Brain imaging studies suggest a brain abnormality in the stricture and function among children and adolescents with CD and adults with
ASPD.
- A small number of children with CD develop schizophrenia bit they represent 20 to 40% of adults with schizophrenia.
- While parent training, multi-modal cognitive behavioural programs and other interventions in childhood effectively reduce CD symptoms,
evidence regarding the long-term outcomes is contradictory.
- New evidence indicates that response to treatment in influenced by variants of genes that are highly prevalent in the population.
Terminology explained
- Antisocial personality disorder (APD) is defined by the following symptoms:
1. Pervasive pattern of disregard for social norms
2. Deceitfulness
3. Impulsivity
4. Irritability
5. Aggressiveness
6. Reckless disregard for the safety of others,
7. Consistent irresponsibility
8. Lack of remorse for what they have done
- Diagnosis applied only at the age of 18 or more. Of following individuals who have been diagnosed with CD before the age of 15.
- Conduct disorder (CD) is defined by the following symptoms:
1. Repetitive and persistent pattern of behaviour in which the basic right of others major age-appropriate social norms or rules are
violates.
2. Destruction of property
3. Deceitfulness
4. Theft
