Forensic Psychiatric Patients Research Articles

Characteristics of forensic psychiatric patients with a neurocognitive disorder.

Emotional and behavioural disturbances accompanying neurocognitive disorders may sometimes lead to a criminal offence. Our knowledge of this specific forensic subpopulation is lagging behind the knowledge on, and attention for, 'classic' psychiatric disorders in forensic populations. To gain knowledge on the prevalence and characteristics of individuals with neurocognitive disorders in the forensic population. This retrospective database study uses an anonymised data-set of the National Database of penitentiary psychiatric centres (PPC) (N = 8391), which collects data on all patients admitted to one of the four PPCs (mental health clinics within the prison system) in The Netherlands since May 2013. Inclusion criterion for this study was the presence of a Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) or Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) diagnostic code belonging to the category of neurocognitive disorders. A DSM-IV-TR or DSM-5 diagnostic code of a neurocognitive disorder was classified in 254 out of 8391 unique individuals, resulting in a prevalence of 3.0% in the total PPC population. The most prevalent diagnosis was unspecified neurocognitive disorder (59.1%). The neurocognitive disorder group significantly differed from a random control group from the database (n = 762) on demographic, clinical and criminological variables. The prevalence of neurocognitive disorders in this real-world clinical sample is remarkably lower than in two earlier studies in similar populations. Also remarkable is the relatively high prevalence of an unspecified neurocognitive disorder. These findings lead us to hypothesise that neurocognitive disorders may be underdiagnosed in this population. Forensic psychiatric settings should evaluate whether they have sufficient expertise available in neuropsychological assessment.

The introduction of virtual reality in forensic mental healthcare - an interview study on the first impressions of patients and healthcare providers regarding VR in treatment.

Recognizing the potential of Virtual Reality (VR) as a powerful technology to support behavior change, the careful introduction of this technology into treatment settings is essential. This is especially important in vulnerable populations like forensic psychiatric patients. This study aims to gain insight from the impressions of both patients and healthcare providers concerning the integration of VR in practice. The study aims to contribute valuable information that guides the introduction of VR technology, ensuring its optimal use in the complex context of forensic mental healthcare. Semi-structured interviews were conducted with healthcare providers (n = 10) working at forensic outpatient clinics and forensic psychiatric patients (n = 8). All participants experienced VR before the interview. Inductive thematic analysis was employed for analyzing the interview data. Patients valued the unique opportunity to simulate personal experiences in VR scenarios and reflect on them with healthcare providers. In addition to positive first impressions, areas for improvement were identified, including the wish for enhanced realism and reduced physical discomfort while immersed in VR. Finally, important factors contributing to the successful introduction of VR were identified. For example, taking into account psychological distress experienced by patients or supporting healthcare providers with implementation resources. The integration of VR into forensic mental healthcare holds great potential for behavior change. However, its immersive characteristics also increase the chance of amplifying psychological distress. This emphasizes the need for caution when using VR- especially when a vulnerable patient group is subjected to triggering scenarios. This study advocates for a gradual introduction of the technology and provides valuable insights into essential elements for this introduction in clinical practice. It highlights that even the initial step of integrating VR into practice - the introduction phase - demands careful planning and a personalized approach. This underscores the need for ongoing refinement and a systematic approach to the overall implementation of VR. These efforts are crucial to fully realize its potential in clinical practice.

Identity and Personality Pathology in Adult Forensic Psychiatric Patients and Healthy Controls.

Since the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), identity impairment has become a diagnostic criterion for all personality disorders. The current study examined the occurrence of identity dimensions, clinically relevant identity impairments and personality pathology, and associations between these constructs in 92 forensic patients and 139 healthy controls. Patients showed higher levels of almost all identity dimensions, identity impairments, personality disorders, and almost all maladaptive personality traits than controls. Various identity dimensions were associated with consolidated identity as well as identity impairments in both groups. Both patients and controls with high ruminative exploration and identity malfunctioning showed more personality pathology. Different associations between identity functioning and particularly antisocial and borderline personality disorder showed to be stronger in patients than in controls. Our results highlight the importance of identity impairment as a crucial criterion to assess and treat personality pathology in forensic patients.

Adverse childhood experiences in forensic psychiatric patients: Prevalence and correlates from two independent Canadian samples

ABSTRACT There is a lack of research examining Adverse Childhood Experiences (ACEs) in forensic psychiatric patients despite research consistently demonstrating a relationship between ACEs and later life mental and physical health issues and likelihood of incarceration. The current study sought to examine the relationships between ACEs and indicators of health and offending among forensic psychiatric patients. Medicolegal files were reviewed and coded for 313 patients from two independent high and low/medium security Canadian forensic psychiatric programs. Findings from both samples revealed higher than previously reported average and cumulative rates of childhood adversity compared to the general population, and rates which were comparable to other forensic samples. Both samples revealed positive relationships between ACEs and both mental health and offending history, while differential patterns between samples emerged for physical health outcomes. Results are interpreted via comparisons between the samples, as well as in reference to previous forensic, correctional, clinical, and community research findings. Although it is clear from these results that ACEs are a significant factor in the forensic psychiatric population, more research is needed to better understand the interactions among, and mechanisms through which, ACEs contribute to offending onset and risk, treatment response, and both mental and physical health outcomes.

Somatische pathologie bij ‘high security’-geïnterneerden

Somatic pathology in high security internees Psychiatric problems of forensic patients have already been identified in Flanders (Belgium), but no research has been done on the occurrence of somatic comorbidity. In order to improve somatic care, the authors aim to map the prevalence and nature of somatic diagnoses and the causes of death. Through a retrospective study, the medical records of all patients admitted and discharged in a high security forensic psychiatric center were analyzed. All somatic diseases were coded dichotomously. In order to obtain the most complete picture possible, various sources of information (file information, measured parameters, laboratory results) were used. The nature of the deaths (natural, unnatural, suicide) and the causes of natural deaths were examined. More than 2/3 of the deaths were caused by suicides. The 3 most prevalent somatic conditions were obesity (38.9%), hypertension (34.4%) and the metabolic syndrome (33.7%). The current study further indicates that certain data were missing in the files, such as registrations of blood pressure measurements, weight and waist circumferences. Therefore, some problems may have remained underdiagnosed and undertreated. As a consequence, there is room for improvement in the detection and monitoring of somatic diseases. This first study demonstrates an important somatic comorbidity in forensic patients with high security needs and may contribute to a better understanding and treatment of physical problems. This aspect of the holistic treatment of forensic-psychiatric patients has been recognized insufficiently, despite its great importance.

Post-discharge pharmacological treatment discontinuation of forensic psychiatric patients in Sweden.

Most forensic psychiatric patients have chronic psychiatric disorders that require long-term pharmacological treatment even after discharge from care. However, the prevalence and correlates of post-discharge medication discontinuation in this patient group remain unclear. The aim of this study was to investigate the prevalence and correlates of post-discharge discontinuation of pharmacological treatment in forensic psychiatric patients in Sweden. Data on individuals discharged from forensic psychiatric care between 2009 and 2018 (n = 1,142) with ongoing pharmacological treatment at the time of discharge (n = 856) were identified from the Swedish National Forensic Psychiatric Register. Cox regression models were used to estimate the association between patient characteristics and medication discontinuation. Of the 856 individuals with pharmacological treatment at discharge, 488 (57%) discontinued treatment within 2 years of discharge. Factors associated with an increased risk of treatment discontinuation varied between different types of psychotropic medications: the most important correlate was comorbidity between psychosis and personality disorder. Higher age at discharge, longer length of stay, having a history of several psychiatric care episodes, having a trustee, having a limited guardian, and a residing in a supported living accommodation at the time of discharge were associated with a decreased rate of medication discontinuation. This applied for antipsychotics, antidepressants, antiepileptics, and any psychotropic medication, but not for psychostimulants or drugs used in addictive disorders. For many former forensic psychiatric patients, there are situational factors associated with medication discontinuation. This insight holds significance for professionals who are involved in pre-discharge planning within forensic psychiatric care and those who interact with this cohort of former patients post-discharge.

Forensic Psychiatric Patients' Experiences of Personal Recovery: A Wilsonian Concept Analysis.

Psychiatric patients' recovery processes have been studied rather extensively, and a relatively clear consensus on what recovery is already exists. We examined whether the personal recovery of forensic psychiatric patients varies from this definition. We conducted a concept analysis to assess the personal recovery of patients in forensic psychiatric hospitals based on 21 articles and then evaluated how our results compared with existing definitions on psychiatric and forensic recovery. On the basis of this comparison, we concluded that the personal recovery of forensic psychiatric patients does differ from that of other psychiatric patients. The recovery process of forensic psychiatric patients can be described through five themes: personal development and autonomy, social inclusion and normality, redemption and overcoming, future orientation and hope, and advancing process. The burden of a psychiatric disorder causes similar challenges, yet a criminal history and long hospitalization periods are distinctive issues for forensic patients, both of which can lead to severe alienation from society and deterioration of skills needed in life outside an institution. The results suggest that processing the criminal offense should be part of the care; furthermore, institutions should support forensic psychiatric patients in their reintegration into society and personal development. Identifying special recovery challenges can be useful when designing effective care and promoting the recovery of forensic patients. Thus, our results suggest that certain features of forensic psychiatric patients' recovery should be considered when planning their psychiatric care.

What happens after forensic psychiatric care? A latent class analysis of dimensions of welfare for former forensic psychiatric patients

BackgroundMentally disordered offenders are a heterogenous group regarding psychopathology as well as background factors, which makes it likely that more than one stereotypical life situation will apply to all forensic psychiatric patients following discharge. Knowledge about typical life situations would be valuable for optimising support for improving the overall life situation of these individuals. This paper investigates life situations from the perspective of level of living research and resources in terms of different welfare dimensions.MethodsIncluded were all all individuals (n = 1146) who had been discharged from forensic psychiatric care in Sweden during 2009–2018 and were included in the Swedish National Forensic Psychiatric Register. Follow-up time varied from 4 to 3644 days, (m = 1697, Md = 1685). Register data from several different registers was combined. Data was analysed using latent class analysis, and multinominal logistic regression analysis investigated what background factors were associated with class membership.ResultsThe results show that there are four subgroups of post-discharge life situations: the high support group, the general psychiatric needs group, the working group, and the family group. The high support group was the largest, representing 54% of the entire sample. There are background factors associated with group membership, including both age at discharge, length of stay in forensic psychiatric care and pre-index crime historical factors.ConclusionsThis study contributes to the understanding of the post-discharge lives of former forensic psychiatric patients and shows that for several subgroups, negative outcomes are rare. Knowledge about these subgroups could be drawn upon to make informed decisions about in- and outpatient forensic psychiatric care, discharge from forensic psychiatric services, and what support is offered to former forensic psychiatric patients.

Reducing Risk for Future Violence From Forensic Psychiatric Patients by Using Critical Factors of the Short-Term Assessment of Risk and Treatability as a Caring Tool.

The dual task for forensic mental health care is community protection and treatment of mental disorders. The Short-Term Assessment of Risk and Treatability (START) has become an established tool for risk assessment and care planning in forensic psychiatry. When using the START, items judged as critical factors are chosen to be addressed in the care plan. However, it is not known which critical factors that are of special interest need to be addressed to reduce the risk for future violence. The main aim of this study was to explore how staff's choice of critical factors in the care planning influences risk for future violence. The study is based on 787 START assessments from 285 convicted and involuntary admitted inpatients at the Forensic Psychiatric Clinic of Stockholm County, Sweden. The influence on risk for future violence by selecting a certain item as a critical factor in the care plan was measured by comparing patients' sum of vulnerabilities at the time this certain critical factor was selected with this sum at the next assessment. The results show that a patient's overall risk for future violence decreases significantly when the items "insight," "attitudes," "mental state," "coping," and "drug use" were addressed as critical factors in the care planning. The importance of specified critical factors differs between diagnostic groups and time after admission. When staff select certain specified items as critical factors in the care planning, the patients' risk of relapse into acts of violence was significantly reduced.

The impact of childhood maltreatment on aggression, criminal risk factors, and treatment trajectories in forensic psychiatric patients

IntroductionChildren’s development into healthy well-functioning adults can be negatively affected by adversity. Adverse childhood experiences (ACEs) have been shown to lead to a variety of poor life outcomes, ranging from mental health problems (e.g., anxiety or suicidality) through problematic health behaviors to serious physical diseases and even early death. ACEs can also make people more prone to aggressive behavior, criminality, and recidivism. In this study, we investigated the association between ACEs, specifically childhood maltreatment (CM), and forensically relevant factors; aggression, criminal risk factors, and treatment trajectories, as little is known about these associations in forensic psychiatric patients.MethodsThe study includes data derived from two studies in The Netherlands, of which the first study enrolled 128 patients residing in a Forensic Psychiatric Center (FPC) and the second study included 468 patients who were released unconditionally from FPCs between 2009 and 2013. We expected that more CM would be correlated with higher levels of aggression, higher clinical risk factor scores, and less decrease in clinical risk factor scores over time. To investigate this, we applied correlational analyses and linear growth curve modeling on risk assessment scores and self-report as well as staff report questionnaires on CM and aggression.ResultsConsistent with our first hypothesis, patients with higher CM scores also had higher aggression and risk assessment scores. The effect sizes were small to medium (0.12 to 0.34). Unexpectedly, CM did not influence the course of these treatment trajectories, however, we found that patients with histories of CM had a significantly longer length of stay in a forensic facility than patients without CM (respectively, 10.8 years and 9.3 years on average).DiscussionThis study underlines the importance of carefully examining the history of ACEs and CM in forensic psychiatric patients and considering this in forensic risk assessment and risk guided treatment. More research is needed to draw conclusions about whether and how histories of ACEs should be considered and targeted during treatment trajectories.

Exploring the added value of virtual reality biofeedback game DEEP in forensic psychiatric inpatient care-A qualitative study.

Low motivation and suboptimal cognitive skills are common among forensic psychiatric patients. By focusing on doing and experiencing, innovative technologies could offer an alternative to existing treatment for this patient group. One promising technology is DEEP, a VR biofeedback game that teaches diaphragmatic breathing, which has shown its potential in reducing stress in other populations. This exploratory study aimed at identifying if, how and for whom DEEP can be of added value in forensic mental healthcare. This study used a qualitative approach. Six focus groups with 24 healthcare providers and 13 semi-structured interviews with forensic psychiatric inpatients were conducted in two Dutch forensic mental healthcare organizations. All healthcare providers and patients experienced DEEP before participating. The data were coded inductively, using the method of constant comparison. The data revealed six themes with accompanying (sub)codes, including (1) the possible advantages and (2) disadvantages of DEEP, (3) patient characteristics that could make DEEP more or (4) less suitable and beneficial, (5) ways DEEP could be used in current treatment, and (6) conditions that need to be met to successfully implement DEEP in forensic mental healthcare. The results showed that DEEP can offer novel ways to support forensic psychiatric patients in coping with negative emotions by practicing diaphragmatic breathing. Its appealing design might be suitable to motivate a broad range of forensic psychiatric patient groups. However, DEEP cannot be personalized, which might decrease engagement and uptake of DEEP long-term. Regarding its place in current care, DEEP could be structurally integrated in existing treatment programs or used ad hoc when the need arises. Finally, this study showed that both healthcare providers and patients would need practical support and information to use DEEP. With its experience-based and gamified design, DEEP could be useful for forensic mental healthcare. It is recommended that patients and healthcare providers are included in the evaluation and implementation from the start. Besides, a multilevel approach should be used for formulating implementation strategies. If implemented well, DEEP can offer new ways to provide forensic psychiatric patients with coping strategies to better control their anger.

Alexithymia and Forgiveness Levels of Forensic Psychiatric Patients.

The current cross-sectional study was performed to examine levels of alexithymia and forgiveness in forensic psychiatric patients. Data were collected between March 2022 and August 2022 at a high-security forensic psychiatric hospital affiliated with a city hospital in Turkey. A personal information form prepared by the researchers, the Toronto Alexithymia Scale, and the Heartland Forgiveness Scale were used to obtain data. Participants comprised 132 forensic psychiatric patients who agreed to participate in the study. A significant negative correlation was found between alexithymia and forgiveness levels of participants (p < 0.01, r = -0.259). In other words, as alexithymia levels increased, participants were found to be less forgiving. In addition, results suggest that forensic psychiatric patients are susceptible to alexithymia and higher levels of forgiveness. Determining forgiveness and alexithymia levels of forensic psychiatric patients will contribute to the structuring of care to be offered to these patients. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Sense of Defeat, Social Status and Oral Health among Forensic Psychiatric Patients

Abstract Aims The aim was to examine how sense of defeat and social status are related to perceived oral health, tooth brushing, and oral health-related quality of life among Dutch male forensic psychiatric patients. Methods The sample consisted of 40 hospitalized forensic psychiatric patients participated. The questionnaire included five questions about moments of tooth brushing, scales for sense of defeat and subjective social status, a scale from 1 to 10 for perceived oral health and a Dutch version of the Oral Health Impact Profile- 14 (OHIP-14). Results The results showed that on the basis of a factor analysis of the OHIP-14, three meaningful scales could be constructed, i.e., functional limitations, social discomfort, and psychological inhibitions. The major results revealed that sense of defeat correlated negatively with tooth brushing after breakfast and before going to sleep, positively with social discomfort because of one’s teeth, mouth, or dentures, not with functional limitations, and negatively with self-perceived oral health. Social status correlated positively with tooth brushing before going to sleep, with psychological inhibitions, but not with social discomfort, and neither with functional limitations. Conclusions and implications The major conclusion is that sense of defeat and social status have theoretically meaningful relations with oral self-care and oral health. Oral health professionals working with male forensic psychiatric patients should be sensitive to the sense of defeat these patients may experience, and to the fact that this may be associated with problems with their oral health and with a lack of oral self-care.

A latent class analysis of mental disorders, substance use, and aggressive antisocial behavior among Swedish forensic psychiatric patients

BackgroundPatients in the forensic mental health services (FMHS) with a mental disorder, a co-occurring substance use disorder (SUD), and high risk of aggressive antisocial behavior (AAB) are sometimes referred to as the ‘triply troubled’. They suffer poor treatment outcomes, high rates of criminal recidivism, and increased risk of drug related mortality. To improve treatment for this heterogeneous patient group, more insight is needed concerning their co-occurring mental disorders, types of substances used, and the consequent risk of AAB. MethodsA three-step latent class analysis (LCA) was used to identify clinically relevant subgroups in a sample of patients (n = 98) from a high-security FMHS clinic in Sweden based on patterns in their history of mental disorders, SUD, types of substances used, and AAB. ResultsA four-class model best fit our data: class 1 (42%) had a high probability of SUD, psychosis, and having used all substances; class 2 (26%) had a high probability of psychosis and cannabis use; class 3 (22%) had a high probability of autism and no substance use; and class 4 (10%) had a high probability of personality disorders and having used all substances. Both polysubstance classes (1 and 4) had a significantly more extensive history of AAB compared to classes 2 and 3. Class 3 and class 4 had extensive histories of self-directed aggression. ConclusionsThe present study helps disentangle the heterogeneity of the ‘triply troubled’ patient group in FMHS. The results provide an illustration of a more person-oriented perspective on patient comorbidity and types of substances used which could benefit clinical assessment, treatment planning, and risk-management among patients in forensic psychiatric care.

VReedom: training for authorized leave of absence through virtual reality - a feasibility study.

This study assessed the feasibility, implementation process and outcomes of the VReedom training; a virtual reality (VR)-based intervention designed to prepare forensic psychiatric patients for their first authorized leave. Clinical forensic mental healthcare organization Inforsa, operating at security level 3, introduced the VReedom training for forensic patients eligible for their first authorized leave, between March 1st and November 13th, 2022. Employing a retrospective observational cohort study design with patient dossier data as the primary source, the study also used participant observation, weekly evaluative questionnaires and focus group discussions as data sources. Five objectives were utilized to evaluate the feasibility: recruitment capacity and resulting sample characteristics, data collection and evaluation procedures, acceptability and suitability of the training and protocol, training management and implementation, and preliminary participant results. Despite the lack of a control group, findings align with literature suggesting VR's potential for enhancing treatment motivation and reducing stress in preparation for first authorized leave. Of 13 patients approached, 10 participated without dropouts, and no incidents occurred during training. Emotion elicitation was successful, supporting VR Exposure therapy's efficacy. Findings align with literature, emphasizing VR's value in forensic psychiatry. Establishing favorable implementation conditions was crucial, with positive reception from treatment providers. Also, the need for personalization and additional locations was identified, and the training seemed most suitable for patients with a tbs-measure. Future research with control groups is recommended to further validate the effectiveness of the VReedom training intervention, and further protocol development is necessary to make it suitable for a broader population. Current findings contribute to the refinement and expansion of evidence-based practices in the field of VR-assisted training and treatment in forensic psychiatry.

Emotion dysregulation – A bridge between ACE and aggressive antisocial behavior

PurposeForensic populations have high prevalence rates of adverse childhood experiences (ACE), but specific pathways from childhood victimization to adult victimizing behavior remain unclear. Difficulties in emotion regulation may prove to be a more proximal risk factor that functions as a pathway between ACE and aggressive antisocial behavior (AAB). In this study, we investigated concurrent associations between ACE, AAB, and difficulties in emotion regulation and tested the mediational role of emotion dysregulation. MethodsA forensic psychiatric inpatient sample (N = 97) was recruited from a maximum-security forensic psychiatric hospital in Sweden. Data were collected through file reviews and self-reports and analyzed with mediation and correlation analyses. ResultsWidespread bivariate associations among the study variables emerged, with small to moderate effect sizes. Distinct emotion regulation difficulties had unique relations to ACE and to different forms of AAB respectively. Evidence of significant indirect effects was limited and inconsistent across different types of analyses. ConclusionsDeficits in emotion regulation might be an important target of change in efforts to reduce AAB in forensic psychiatric patients with past ACE exposure. Attention to different dimensions of emotion regulation is crucial to deliver comprehensive interventions.

An Examination of Predictive Validity and Change in Risk Factors for Stalking over Time.

This study investigates the predictive validity of two risk instruments for stalking, the Guidelines for Stalking Assessment and Management (SAM) and the Stalking Risk Profile (SRP), in a sample of 86 forensic psychiatric patients. We compare these tools against a well-validated violence risk assessment measure (Historical, Clinical, Risk Management-20, Version 3 (HCR-20V3)) for violent and stalking-related outcomes. Dynamic (mutable) components of each tool were rated at three annual intervals and revealed significant change across time. The HCR-20V3, SAM, and SRP measures showed comparable ability to classify those who recidivated with further stalking from those who did not (area under the curves = .72-.73, P < 001). Time-varying scores from the dynamic subscales of the HCR-20V3 and SAM contributed significantly to the prediction of stalking, whereas nonstalking violence was primarily forecast by the static (Historical) scale of the HCR-20V3. This suggests comparable validity of general violence and stalking risk tools for assessing the risk of stalking in forensic patients. Stalking-specific risk factors on the SAM and SRP will likely be of added clinical value in terms of tailoring risk management and treatment plans. Findings also emphasize the importance of attending to changes in risk status over time and incorporating time-sensitive methodologies into predictive models.

Offenders and non-offenders with schizophrenia spectrum disorders: the crime-preventive potential of sufficient embedment in the mental healthcare and support system.

Suffering from schizophrenia spectrum disorder (SSD) has been well-established as a risk factor for offending. However, the majority of patients with an SSD do not show aggressive or criminal behavior. Yet, there is little research on clinical key features distinguishing offender from non-offender patients. Previous results point to poorer impulse control, higher levels of excitement, tension, and hostility, and worse overall cognitive functioning in offender populations. This study aimed to detect the most indicative distinguishing clinical features between forensic and general psychiatric patients with SSD based on the course of illness and the referenced hospitalization in order to facilitate a better understanding of the relationship between violent and non-violent offenses and SSD. Our study population consisted of forensic psychiatric patients (FPPs) with a diagnosis of F2x (ICD-10) or 295.x (ICD-9) and a control group of general psychiatric patients (GPPs) with the same diagnosis, totaling 740 patients. Patients were evaluated regarding their medical (and, if applicable, criminal) history and the referenced psychiatric hospitalization. Supervised machine learning (ML) was used to exploratively evaluate predictor variables and their interplay and rank them in accordance with their discriminative power. Out of 194 possible predictor variables, the following 6 turned out to have the highest influence on the model: olanzapine equivalent at discharge from the referenced hospitalization, a history of antipsychotic prescription, a history of antidepressant, benzodiazepine or mood stabilizer prescription, medication compliance, outpatient treatment(s) in the past, and the necessity of compulsory measures. Out of the seven algorithms applied, gradient boosting emerged as the most suitable, with an AUC of 0.86 and a balanced accuracy of 77.5%. Our study aimed to identify the most influential illness-related predictors, distinguishing between FPP and GPP with SSD, thus shedding light on key differences between the two groups. To our knowledge, this is the first study to compare a homogenous sample of FPP and GPP with SSD regarding their symptom severity and course of illness using highly sophisticated statistical approaches with the possibility of evaluating the interplay of all factors at play.

General and violent recidivism of former forensic psychiatric patients in Finland.

Forensic psychiatric care in Finland is provided to individuals who have committed a crime due to a serious mental disorder and are in need of psychiatric care. The reconviction (recidivism) rates for this patient group vary in time and between countries, likely due to different treatment practices and requirements for forensic care. We set out to study criminal recidivism in a national cohort of all patients released from forensic psychiatric care in Finland between 1999 and 2018. National registries were used to identify the patients and gain information on their criminal sentences. Forensic psychiatric examinations were used to record demographic information for the cohort. The cohort was followed up from hospital discharge to the end of 2019. We identified a total of 501 patients who were released from forensic psychiatric care (mean age: 46.6 years [SD 13.4), 434 (86.6%) were male). The mean and median times spent in treatment for the cohort was 10.0 years [SD 6.5] and 8.7 years, respectively. 91% of the patients had schizophrenia spectrum disorder (F2*), and 63.5% had a substance use disorder. A total of 83 patients (16.6%) committed any crime after being released from care, and the mean time to recidivism was 3.8 years. The recidivism rate was 2015 per 100,000 person years. A total of 48 patients (9.6%) committed a violent crime. The mean time to violent recidivism was 4.2 years. The violent recidivism rate was 1,083 per 100,000 person years. A longer duration of treatment was associated with a decreased risk of general recidivism (HR 0.95, 95% CI 0.90 to 1.00, p = 0.05). Factors associated with higher recidivism were male sex, having a comorbid substance use disorder and younger age at discharge. The recidivism rate in Finland was markedly lower than has been previously reported for other Western countries, and the mean duration of treatment was also longer. A longer treatment time may reduce the risk of criminal recidivism in forensic psychiatric patients. The results suggest, as previous studies have found, that more effort is indicated on the treatment of substance abuse.

Nationwide study on antipsychotic polypharmacy among forensic psychiatric patients

ABSTRACT This nationwide retrospective cross-sectional study examines the prevalence of antipsychotic polypharmacy (APP) and demographic, forensic, and clinical factors associated with its practice among Greenlandic forensic psychiatric patients. We collected data from electronic patient files, court documents, and forensic psychiatric assessments. We defined APP as two or more concurrent prescriptions of antipsychotic medication. The study population of 74 patients had a mean age of 41.4 years, and 61 were men. All included patients had either schizophrenia or another ICD-10 F2-diagnosis. We used unpaired t-tests and Chi2 or Fisher’s exact test. The prevalence of APP was 35% (n = 26), and there was a significant association between APP and a prescription of clozapine (Chi2, p = 0.010), olanzapine (Fisher’s test, p = 0.003), and aripiprazole (Fisher’s test, p = 0.013). Furthermore, we found a significant association between APP and prescription of a first-generation antipsychotic (FGA) (Chi2, p = 0.011). Despite recommendations in guidelines, the use of APP is common practice. The majority of forensic psychiatric patients suffer from severe psychiatric disorders, often with other comorbidities, including substance use disorder. The severity and complexity in mental health render forensic psychiatric patients at high risk of APP treatment. Further knowledge on APP use is crucial to secure and further improve the psychopharmacological treatment for this group of patients.