Forensic Psychiatric Population Research Articles

Karolinska Scales of Personality in a forensic psychiatric population: Stability over time and between situations

Assessment of personality traits by means of the Karolinska Scales of Personality (KSP) was made in connection with a forensic psychiatric investigation and at follow-up after 2 years. For some subjects, major life events had occurred between the assessments - in some cases positive events such as marriage, having children, starting regular studies or employment, or receiving psychotherapeutic treatment. In many cases. however, the events or circumstances during the 2-year interval were negative, such as relapse in criminality, incarceration in prison for the whole period between the ratings, or development of a schizophrenic disorder. Moreover, the second assessments were performed in various settings. No significant differences between the two ratings were found in the traits Impulsiveness, Monotony avoidance, or Socialization. Measures of Indirect and Verbal aggression and Irritability also remained stable, as did measures of Guilt and Social desirability. Thus. KSP personality traits related to psychopathy and aggressiveness proved to be stable over time independent of life events. Moderate to high correlations between scores obtained on the two occasions were found for most scales. However, scores of all anxiety-related scales were lower at the second assessments, as in other disordered populations.

Psychopathy and Axis I and Axis II psychiatric disorders in a forensic psychiatric population in Sweden

The relationship between psychopathy and mental disorders was investigated in 61 male subjects during a forensic psychiatric examination. The Psychopathy Checklist Revised (PCL-R) and the Structured Clinical Interview for DSM-III-R (SCID) were used for the assessments. Although psychotic subjects were excluded, the overall psychiatric morbidity in the study population was high. Comorbidity was common, irrespective of the degree of psychopathy. Psychopathy was strongly positively correlated with substance abuse/dependence but negatively correlated with depression. Almost all of the subjects with high PCL-R scores had DSM-III-R antisocial and/or borderline personality disorders. However, some subjects with antisocial personality disorders had medium or low PCL-R scores. When the subjects were reassessed with diagnoses of DSM-IV and ICD-10 personality disorders, the difference between psychopathy and antisocial personality disorder was reduced.

Recurrent self-injurious behavior in forensic patients.

A high prevalence of self-injurious behavior has been reported in the forensic psychiatric population and the correctional psychiatric population. Severely and recurrently self-destructive patients pose great therapeutic challenges. The present study examined forensic patients who engaged in multiple acts of self-injury while hospitalized and compared them to forensic patients who engaged in a single act of self-injury. The groups did not differ on demographic or diagnostic measures, but the recurringly self-injurious patients were more frequently and more severely aggressive against others (verbally as well as physically), and required longer hospitalization. The results are interpreted to suggest that the high cost of recurring self-injury in human and financial terms may be reduced by a strategy of early and vigorous intervention.

Case report: Asperger's syndrome and sexual offending

Abstract A number of case reports have been published that describe offending behaviour in people with developmental disorders. None of the offences referred to in these case reports however, has been sexual in nature. The authors describe a case of Asperger's Syndrome where the diagnosis was made in adulthood after the patient had committed several sexual offences. This case raises the possibility that developmental disorders may go unrecognized among forensic psychiatric populations and that they could be an important consideration in certain offences. The kind of behavioural problems typical of Asperger's Syndrome are seen to be clearly related to the offending behaviour.

Correlates of the woodcock-johnson reading comprehension and kaufman brief intelligence test in a forensic psychiatric population

Assessing the forensic psychiatric patient remains an ongoing challenge. This study assessed the intellectual status of lower-functioning incarcerated adult males with the Woodcock-Johnson Reading Comprehension subtest and the Kaufman Brief Intelligence Test. The results of this study have led the authors to argue for a broad-based assessment model that focuses on the demands and constraints of the dispositional setting.

Neuropsychological and clinical correlates of murder and other forms of extreme violence in a forensic psychiatric population.

The neuropsychological and clinical correlates of extreme violence were examined retrospectively in young and older inpatients of a forensic psychiatric hospital. The young group exhibited significantly higher rates of both a learning disability and a history of childhood conduct disorder, whereas the older group had a significantly higher rate of psychosis. The older individuals charged with murder were also more likely to have acted alone and to have had an intimate relationship with the victim. These results suggest that age, specific clinical and neuropsychological variables, and the characteristics of the violent act may represent important variables for risk models of violence.

Use of Applied Behavior Analysis in Treating Nursing Home Residents

Hospital and Community Psychiatry February 1992 Vol. 43 No.2 171 live forpersons released from jail may put formerly incarcerated persons at increased risk of homelessness. Caution should be exercised in generalizing these results to all jailed persons with mental illness because the data pertained to those who entered and left the system within a six-month period. Furthermore, homelessness data were limited to self-reports. However, it is evident from these data that persons who were most at risk of homelessness in a jailed mentally ill population were those with the most severe psychiatnc disabilities. Analyses were also limited by exclusion ofother important factors that contribute to homelessness, such as socioeconomic status, availability ofsocial supports, and use of mental health services before arrest. Given the disabilities ofthese persons, the possibility that the most difficult psychiatric patients are left to the criminal justice and homeless service systems must be addressed. The mental health system needs to provide assertive outreach-oriented services ifit is to reach these patients. Assertive case management for homeless mentally ill persons has shown some promise (9). We are currently assessing, by randomized clinical trial, a team approach to intensive case management using aggressive outreach and in vivo skill training with a forensic homeless psychiatric population.

Evaluating MMPI Validity in a Forensic Psychiatric Population

The MMPI scores of 353 forensic psychiatric patients were examined to determine the validity scale characteristics of this population. Frequency distributions are provided for L, F, K, F-K, and O-S. These findings suggest that traditional cutoffs for these scales are of questionable use in determining the validity of MMPI scores for this population. It is suggested that elevations on validity measures in this population may be due to characterological features, substance abuse, and the presence of acute psychopathology in addition to deliberate efforts to deceive. The validity and clinical scale characteristics of a small group of identified malingerers ( n = 10) were compared to those of psychotic patients and were found to be distinctly different. Malingerers scored significantly higher on all “fake bad” validity measures (F, F-K, and O-S) and all clinical scales except 5 and 9, and lower on L and K. The clinical implications of these findings are discussed.

Discriminant validity of the Psychopathy Checklist in a forensic psychiatric population.

The association between psychopathy and other mental disorders was investigated in 80 male forensic patients. Psychopathy was assessed with the Psychopathy Checklist (PCL). Diagnoses of other mental disorders were based on Axis I and Axis II criteria listed in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) and on two standardized psychiatric rating scales

Discriminant validity of the Psychopathy Checklist in a forensic psychiatric population.

Discriminant validity of the Psychopathy Checklist in a forensic psychiatric population.

Application of the Megargee MMPI Typology to a Forensic Psychiatric Population

Generalizability of a previously established MMPI-based classification system that was developed using a criminal population (Megargee & Bohn, 1979) was investigated using a sample of 151 patients in a forensic psychiatry unit. Comparison of Megargee and Bohn's (1977) prisoners and the forensic sample indicated significantly different proportions occurring for three of the ten groups with significantly higher proportion of the forensic sample occurring in the five more elevated profile types. Comparison of the three most common groups revealed a significant difference on the Beck Hopelessness Scale. These findings are taken to support the applicability of the Magargee system to a hospitalized population.

Norms, reliability, and item analysis of the Hopelessness Scale in general psychiatric, forensic psychiatric, and college populations.

Administered the Hopelessness Scale to 99 criminal psychiatric inpatients, 118 general psychiatric inpatients, and 197 upper-level college students. Normative data were reported for each group. Both of the psychiatric groups endorsed significantly more items in the hopeless direction than did the college student sample. The scale was found to be more reliable with the psychiatric patients than with the college students. The difference in reliability may reflect the restriction of range of hopelessness scores among college students. An item analysis of the Hopelessness Scale for each of the three groups was presented. These data suggest that three items (4, 5, 13) were not measuring hopelessness as reflected in the other items. Suggestions for further research with the Hopelessness Scale to clarify the components of hopelessness in nonpsychiatric populations were presented.