DUAL PATHOLOGY AND CRIMINAL BEHAVIOR IN PATIENTS CONSIDERED NOT GUILTY BY REASON OF INSANITY. A RETROSPECTIVE STUDY

Abstract

Objectives Previous studies have reported that substance misuse (including alcohol) was the strongest risk factor for violence among psychiatric diagnoses, and absolute rates of violence perpetration of over 10% in substance misuse have been found, meaning that it is an important adverse outcome for clinicians to consider. However, very few studies exist about differences in individuals considered not guilty by reason of insanity (NGRI) with only a primary psychiatric diagnosis and those with dual pathology. This study aims to compare these two groups regarding criminal history and violence. Material and Methods We analyzed a sample of 44 inpatients committed under security measure in the Forensic Psychiatry Regional Department of Lisbon’s Psychiatric Hospital Centre, after being deemed NGRI and dangerous. Data regarding previous history of substance use, psychiatric disorder and criminal history was retrospectively collected. Results and conclusions Unlike what is described in literature for other groups, in our sample of NGRI patients, dual pathology was significantly associated to having no previous violent behavior; furthermore, regarding the offense for which they were considered NGRI, patients with dual pathology were not more likely to have committed a violent crime when compared with patients with only a primary diagnosis. This may be explained because the primary illness (and not other psychosocial factors or substance misuse) was considered the primary reason for having committed the offense, and many patients were committed for domestic violence in the context of developmental disorders, an independent risk factor for violence against relatives. There was no difference between the two groups regarding other variables. Our study highlights that drug and substance misuse may be a less important factor regarding violence in the context of insanity than in other types of violence.