Abstract
Background: Extant research has provided evidence for disparities between patients with schizophrenia spectrum disorder (SSD) who have and have not experienced childhood maltreatment (CM) in terms of treatment outcome, psychopathology and their propensity to engage in offending behavior. However, research addressing all phenomena is scarce.Objective: The current study aims to explore differences between offender patients with SSD and CM and those with SSD and no CM in terms of their offending, psychopathology at different points in time and treatment outcome.Method: In the present explorative study, latent class analysis was used to analyze differences between 197 offender patients with SSD and CM and 173 offender patients with SSD and no CM, who were admitted to forensic psychiatric inpatient treatment between 1982 and 2016 in Switzerland.Results: Three distinct homogenous classes of patients were identified, two of which were probable to have experienced significant CM. One third of patients with SSD and CM were probable to benefit from inpatient treatment, even surpassing results observable in the group without CM, whereas the other group with SSD and CM was probable to benefit less. Patients with SSD and no CM displayed more psychopathology at first diagnosis and prior to their index offense. Interclass differences in offending behavior were minimal.Conclusions: Offender patients with SSD and CM differ not only from offender patients with SSD and no CM, but also amongst themselves. While some with SSD and CM experience a remission in psychopathology and improve their prognosis for future offending behavior, others do not. Directions for future research on SSD and CM are discussed.
Highlights
Patients with schizophrenia spectrum disorders (SSD) and offending behavior are a significant population in forensic psychiatry
While childhood maltreatment (CM) might be seen as an unspecific risk factor for various psychiatric diseases [9, 10], some evidence revealed a link between SSD and specific types of CM such as emotional abuse [6, 8] or emotional neglect [7, 9, 10] compared to other psychiatric diseases
The present study aims to identify subgroups of patients with SSD based on treatment outcome and the presence of various patient characteristics, such as the specific types of CM, psychopathology, and types of violent and non-violent offending
Summary
Patients with schizophrenia spectrum disorders (SSD) and offending behavior are a significant population in forensic psychiatry. Evidence suggests that the rate of offending behavior (i.e., illegal violent and non-violent aggression against others) may be twice as high in patients with SSD, in comparison to the overall population, even if age, substance use and socio-economic factors are controlled for [1,2,3]. Among the numerous studies on the possible underlying reasons for this association, childhood maltreatment (CM) has been recurrently identified to at least double the odds for both, substance use and offending behavior in patients with SSD [4]. Extant research has provided evidence for disparities between patients with schizophrenia spectrum disorder (SSD) who have and have not experienced childhood maltreatment (CM) in terms of treatment outcome, psychopathology and their propensity to engage in offending behavior.
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