Clinical Characteristics and Pharmacological Treatment of Individuals With and Without Intellectual Disability in Pre-trial Assessment-A Population-Based Study.

Hanna Edberg,Tatja Hirvikoski,Peter Andiné,Henrik Larsson,Qi Chen

doi:10.3389/fpsyt.2020.573989

Abstract

Background: The current lack of knowledge about intellectual disability (ID) in forensic psychiatric contexts can compromise the legal certainty of these individuals during the medico-legal process. To address ambiguous results in previous literature, the aim of the current study was to estimate the prevalence of ID in a pre-trial forensic psychiatric settings. Moreover, as little is known about the characteristics of offenders with ID, we conducted a clinical characterization of individuals with and without ID being subject to forensic psychiatric assessment.Methods: Using data from several Swedish national registers, we conducted a population-based retrospective observational study on 8,442 individuals being subject to pre-trial forensic psychiatric assessments in Sweden in 1997–2013. We performed univariate analyses to compare the characteristics of individuals with (n = 537) and without ID (n = 7,905).Results: The prevalence of ID was 6.4% in the Swedish pre-trial forensic psychiatric context during the observational period. Compared with individuals without ID, individuals with ID were younger at the time of assessment, had a lower educational level, and had less frequently started families. ID was associated with lower frequency of diagnosed psychotic and bipolar disorders. However, a similar prescription rate of antipsychotics, and a comparable rate of previous inpatient care was observed among individuals with and without ID. Individuals with ID had more often been prescribed anti-libidinal treatments often used for treating sexual disorders, although did not present a higher prevalence of sexual disorder.Conclusions: The prevalence of ID among pre-trial individuals being subject to forensic psychiatric assessment was more than twice as high as assumed in the general population. Our results suggest that individuals with ID received pharmacotherapy without clear indication. Remaining challenges in the clinical management of individuals with ID were indicated by the discrepancy between the occurrence of psychiatric diagnoses, pharmacological treatment patterns, and rates of inpatient care.

Highlights

Intellectual disability (ID) is characterized by early onset significant impairment of intellectual functioning and adaptive behaviors [1, 2]
Psychiatric diagnoses and psychiatric inpatient care prior to the forensic psychiatric assessment were obtained from the National Patient Register (NPR)
The diagnoses in NPR are coded according to the International Classification of Diseases (ICD) [2, 49]

Summary

Introduction

Intellectual disability (ID) is characterized by early onset significant impairment of intellectual functioning and adaptive behaviors [1, 2]. Previous studies on large Swedish cohorts have indicated that individuals with impaired intellectual ability have a significantly higher risk of criminal and violent behavior than the average population [9, 23]. These studies have applied a less distinctive definition of intellectual disability than current practices, including borderline ID (intelligence quotient 70–85). To address ambiguous results in previous literature, the aim of the current study was to estimate the prevalence of ID in a pre-trial forensic psychiatric settings. As little is known about the characteristics of offenders with ID, we conducted a clinical characterization of individuals with and without ID being subject to forensic psychiatric assessment

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