Regulation of impulsive and aggressive behaviours by a novel lncRNA.

High impulsive and aggressive traits associate with poor behavioural self-control. Despite their importance in predicting behavioural negative outcomes including suicide, the molecular mechanisms underlying the expression of impulsive and aggressive traits remain poorly understood. Here, we identified and characterized a novel long noncoding RNA (lncRNA), acting as a regulator of the monoamine oxidase A (MAOA) gene in the brain, and named it MAOA-associated lncRNA (MAALIN). Our results show that in the brain of suicide completers, MAALIN is regulated by a combination of epigenetic mechanisms including DNA methylation and chromatin modifications. Elevated MAALIN in the dentate gyrus of impulsive-aggressive suicides was associated with lower MAOA expression. Viral overexpression of MAALIN in neuroprogenitor cells decreased MAOA expression while CRISPR-mediated knock out resulted in elevated MAOA expression. Using viral-mediated gene transfer, we confirmed that MAALIN in the hippocampus significantly decreases MAOA expression and exacerbates the expression of impulsive-aggressive behavioural traits in CD1 aggressive mice. Overall, our findings suggest that variations in DNA methylation mediate the differential expression of a novel lncRNA that acts on MAOA expression to regulate impulsive-aggressive behaviours.

How do childhood conduct problems, callousness and anxiety relate to later offending and adult mental disorder?

BACKGROUND: Various combinations of childhood conduct problems, callous traits and anxiety may confer increased risk of offending, psychopathic traits and mental disorders. Knowledge of these outcomes in adulthood is limited. AIMS: To compare adult criminal convictions, psychopathy checklist scores and mental disorders between five groups of men, variously defined in childhood by: (1) callous traits, (2) conduct problems, (3) conduct problems and callous traits, (4) conduct problems and callous traits and anxiety or (5) developing typically. METHOD: Teachers rated conduct problems, callous traits and anxiety at ages 6, 10 and 12 years. Criminal convictions from age 12 to 24 were extracted from official records. The Psychopathy Checklist-Revised (PCL-R) and diagnostic interviews were completed at age 33. RESULTS: Relative to the typically developing group, the groups with conduct problems, with and without callous traits and anxiety, showed 5-fold elevations in risks of violent convictions and 3 to 4-fold elevations in risk for antisocial personality disorder, while the groups with conduct problems only and with conduct problems plus callous traits plus anxiety were at increased risk for borderline personality disorder. All risk groups obtained higher PCL-R total scores than the typically developing childhood group. CONCLUSIONS AND IMPLICATIONS: It is widely accepted that childhood conduct problems in boys are associated with increased risks of criminal convictions and poorer mental health, but our findings suggest that teachers can identify different subgroups and these have different trajectories. As some subgroups were small, replication is recommended, but our findings offer preliminary support for trialling specific interventions for at risk boys.

[Frequency and type of offences committed by men with severe mental disorders by age of antisocial behaviors onset]. / Fréquence et Type de Délits Commis Par des Hommes Atteints de Troubles Mentaux Graves Selon l'âge D'apparition Des Comportements Antisociaux.

OBJECTIVE: There are important differences in frequency and type of offence committed by individuals with severe mental disorders (SMD), depending on whether their antisocial behaviors began at an early age or as adults. However, individuals having shown early antisocial behaviors do not form an homogenous group. This study's objective is to test if the antisocial behaviors earliness could explain this heterogeneity. METHOD: 137 men with SMD under 3 separate legal status were recruited. They were distributed in 3 groups according to the antisocial behaviors earliness. RESULTS: The participants in the childhood group commit more violent offences and more of them present a substance use disorder compared with those in the adult group. A more frequent alcohol use disorder separates the youth group from the adult group. There is no significant difference between the childhood and the youth group, but there are more reported offences in the childhood group. CONCLUSIONS: Our results suggest that the age of antisocial behaviors onset should be considered in evaluating risk and managing individuals with SMD.

OBJECTIF: Il y a des différences importantes quant à la fréquence et au type de délit commis par les personnes atteintes de troubles mentaux graves (TMG), selon que leurs comportements antisociaux ont débuté en bas âge ou à l'âge adulte. Cependant, les personnes ayant manifesté des comportements antisociaux précoces ne forment pas un groupe homogène. La présente étude a pour objectif de vérifier si la précocité des comportements antisociaux peut expliquer cette hétérogénéité. MÉTHODE: 137 hommes atteints d'un TMG sous trois statuts légaux distincts ont été recrutés. Ils ont été séparés en 3 groupes selon la précocité des comportements antisociaux. RÉSULTATS: Les participants du groupe enfance commettent plus de délits violents et sont plus nombreux à présenter un trouble de l'usage de drogues que ceux du groupe adulte. Le groupe adolescence se distingue du groupe adulte par une fréquence plus élevée de trouble de l'usage d'alcool. Aucune différence ne s'avère significative entre les groupes enfance et adolescence, mais la plupart des délits rapportés sont plus nombreux dans le groupe enfance. CONCLUSIONS: Les résultats suggèrent que l'âge d'apparition des comportements antisociaux devrait être pris en compte dans l'évaluation du risque et la prise en charge des personnes atteintes d'un TMG.

Supportive housing and forensic patient outcomes.

In Canada, Review Boards are mandated to evaluate individuals found Not Criminally Responsible on Account of Mental Disorder (NCRMD) on an annual basis and render 1 of 3 dispositions: (a) custody, (b) conditional discharge, or (c) absolute discharge. To promote social reintegration, conditional discharge can be ordered with the condition to live in supportive housing. However, NCRMD accused face great barriers to housing access as a result of the stigma associated with the forensic label. The goal of this study was to evaluate the role of housing in the clinical and criminal trajectories of forensic patients as they reintegrate into the community. Data for this study were extracted from a national study of individuals found NCRMD in Canada (Crocker, Nicholls, Seto, Côté, et al., in press). The present study focuses on a random sample of NCRMD accused in the province of Québec, who were under a conditional discharge disposition during the study period (n = 837). Controlling for sociodemographic, clinical, and criminal variables, survival analysis showed that individuals placed in independent housing following a conditional discharge from the Review Board were 2.5 times more likely to commit a new offense, nearly 3 times more likely to commit an offense against a person, and 1.4 times more likely to be readmitted for psychiatric treatment compared with individuals residing in supportive housing. These results point to the influence housing can have on the trajectories of forensic patients, above and beyond a range of clinical, criminological, and sociodemographic factors.

Evaluation of Practice Tools for Asthma and Cough in Primary Care: A Knowledge-to-Action Perspective.

Asthma and cough are two common chronic conditions whose incidence could be reduced with appropriate prevention and treatment measures. Practice tools can be effective in helping to translate emerging research evidence into clinical practice. This study assesses the extent to which two asthma and cough practice tools are used in primary care. Thirty-six primary care physicians completed a questionnaire on the use, usefulness, and relevance of the two tools, and identified barriers to their use. Results show that the tools are seldom used, even though physicians find them useful and adapted to their practice. Time constraints are the primary barrier to use, followed by a lack of organizational resources. Findings from the study will inform the continued development of effective knowledge transfer tools that are aligned with the specific practice contexts of primary care physicians.

Clinical characteristics and service use of incarcerated males with severe mental disorders: a comparative case-control study with patients found not criminally responsible.

Since the drop in the bed capacity of civil psychiatric hospitals, an increase in the bed capacity of forensic psychiatric care and prison units has been reported in the United States and Europe. However, in Canada, a decrease in the number of people with severe mental illness (SMI) during the last two decades in penitentiaries has been reported. At the same time, an increase in individuals found not criminally responsible on account of mental disorder (NCRMD) was observed in forensic hospitals. The aim of this study is to compare incarcerated severely mentally ill (I-SMI) individuals with forensic-hospitalized SMI individuals in terms of their clinical profiles and service use in the province of Quebec (Canada). A case-control study design was selected using a sample of 44 I-SMI individuals and 59 forensic-hospitalized SMI individuals. Important findings include the following: I-SMI persons had less schooling; they more often reported suicide attempts and violent and non-violent crimes; and they had a higher level of comorbidity involving Cluster B personality disorders and substance-use disorders. Forensic-hospitalized SMI persons were more likely to have been receiving psychiatric follow-up before hospitalization. The final logistic regression model showed that lifetime suicide attempts, non-violent crimes, and psychopathic traits were higher among I-SMI individuals than among forensic-hospitalized SMI individuals. In contrast, receiving regular psychiatric follow-up was associated with forensic-hospitalized SMI individuals. Differences in psychopathological characteristics and the use of mental health services were found for I-SMI persons. More research is needed to determine which new initiatives might be efficacious in addressing the mental health needs of I-SMI individuals.

Risk assessment instruments in clinical practice.

OBJECTIVE: To determine whether the items in one of the most widely validated instruments of violence risk assessment, the Historical-Clinical-Risk Management-20 (HCR-20), are used in review board hearings to assess the risk of violence by people found Not Criminally Responsible on account of Mental Disorder (NCRMD). METHOD: This study was conducted from October 2004 to August 2006 in Quebec's sole forensic psychiatric hospital and 2 large civil psychiatric hospitals designated for the care of people declared NCRMD in the Montreal metropolitan area. The risk assessments presented by clinicians at annual review board hearings and the boards' rationale for the release or detention of people found NCRMD were contrasted with the risk assessments conducted by the research team using the HCR-20. The final sample was comprised of 96 men. RESULTS: Very few of the risk factors identified by prior research (HCR-20 items) were mentioned in the hearing process, whether in clinical reports, discussions during the hearing, or in the disposition justification. CONCLUSIONS: The findings confirm that there remains a significant gap between research evidence and risk assessment practice.

To detain or to release? Correlates of dispositions for individuals declared not criminally responsible on account of mental disorder.

OBJECTIVE: The extent to which risk assessment advances have influenced release decision-making by review boards (RBs) of individuals found not criminally responsible on account of mental disorder (NCRMD) remains unclear. Our objective is to identify the psychosocial, criminological, and risk measure correlates of RB decision-making. METHOD: Data were collected through structured interviews and file reviews conducted between October 2004 and August 2006 in the sole forensic psychiatric hospital in Quebec and in 2 civil psychiatric hospitals in a large metropolitan area designated to care for people found NCRMD. The final sample consisted of 96 men. RESULTS: Dynamic, clinical risk factors are associated with decisions to detain or release people found NCRMD, rather than traditional historical risk factors such as criminal history. CONCLUSION: Dynamic variables seem appropriate for the RBs to consider given the intention of the NCRMD legislation. Further, dynamic variables provide direction for titration of treatment and supervision. Results are discussed regarding enhancing evidence-informed RB dispositions.

Clinical and sociodemographic profiles of male inmates with severe mental illness: a comparison with voluntarily and involuntarily hospitalized patients.

OBJECTIVE: To identify the clinical specificity of men with severe mental illness (aged 18 to 40 years) by legal status. METHOD: Our study compared 85 inmates with 66 involuntarily hospitalized patients (IHPs) and 50 voluntarily hospitalized patients (VHPs) with at least one Axis I diagnosis of psychosis or major affective disorder. Sociodemographics, medical information, and criminal history were drawn from interviews, medical records, and official criminal records. We used the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders to determine Axis I disorders and antisocial personality disorder (ASPD). Psychopathy was measured with the Psychopathy Checklist--Revised. RESULTS: We found that inmates had a lower level of schooling (P = 0.001), were more likely to have been in an intimate relationship (P < 0.001), and were less likely to have a psychiatric hospitalization history (P < 0.001), compared with hospitalized patients. Inmates were also more likely to meet criteria for delusional disorders or psychosis not otherwise specified (P < 0.001) and major depression (P = 0.001). IHPs were more likely to meet schizophrenia spectrum disorder criteria (P < 0.001). Inmates had a higher level of comorbidity involving ASPD (P < 0.001), psychopathy (P < 0.001), and substance misuse (P < 0.001). IHPs showed an intermediate level between inmates and VHPs for these comorbid disorders. VHPs had the lowest level of comorbidity with Axis I psychiatric diagnosis. CONCLUSION: Our clinical specificity hypothesis was supported: different psychopathological characteristics and social functioning profiles were identified by legal status. Specific integrated treatments should be considered for inmates and IHPs.

Anxiety disorders among offenders with antisocial personality disorders: a distinct subtype?

OBJECTIVES: about 50% of men with antisocial personality disorder (APD) present a comorbid anxiety disorder. Historically, it was thought that anxiety limited criminal activity and the development of APD, but recent evidence suggests that heightened responsiveness to threat may lead to persistent violent behaviour. Our study aimed to determine the prevalence of APD comorbid with anxiety disorders among offenders and the association of these comorbid disorders with violent offending. METHOD: a random sample of 495 male penitentiary inmates completed an interview using the Diagnostic Interview Schedule. After excluding men with psychotic disorders, 279 with APD were retained. All authorized access to their criminal records. RESULTS: two-thirds of the prisoners with APD presented a lifetime anxiety disorder. Among them, one-half had the onset of their anxiety disorder before they were aged 16 years. Among the offenders with APD, those with, compared with those without, anxiety disorders presented significantly more symptoms of APD, were more likely to have begun their criminal careers before they were aged 15 years, to have diagnoses of alcohol and (or) drug abuse and (or) dependence, and to have experienced suicidal ideas and attempts. While there were no differences in the mean number of convictions for violent offences between APD prisoners with and without anxiety disorders, more of those with anxiety disorders had been convicted of serious crimes involving interpersonal violence. CONCLUSIONS: among men with APD, a substantial subgroup present life-long anxiety disorders. This pattern of comorbidity may reflect a distinct mechanism underlying violent behaviour and signalling the need for specific treatments.

[Validation of the French version of "Self Appraisal of Illness Questionnaire"]. / Validation de la version française du "Self Appraisal of Illness Questionnaire".

Poor insight into mental illness is associated with treatment non-compliance, relapse and re-hospitalization. Measuring insight becomes therefore important in assessing risk of non-compliance. A few reliable insight instruments are available in English. Self Appraisal of Illness Questionnaire (SAIQ) (Marks & al., 2000) was translated in French and validation analysis was performed. The 17 items French version is called Questionnaire d'autoévaluation de l'introspection (QAI). Cronbach's alpha showed 0.78 for internal consistency (N = 124). Factor analysis generated three factors explaining 49.8 % of the variance. They were: Need for treatment (Awareness of), Worry and Presence/Outcome of mental disorder. Concurrent validity analysis of QAI and Insight Scale (IS) (Markova & al., 2003) resulted in a coefficient of 0.37. QAI demonstrated solid psychometric properties and should be further reassessed in research and clinical practice. It is well adapted for use in hospital and clinical setti

Trace elements among a sample of prisoners with mental and personality disorders and aggression: correlation with impulsivity and ADHD indices.

OBJECTIVES: Mental, personality and substance use disorders are over represented among prisoners and aggressive individuals. The psychopathological and biological markers linked to mental functioning remain still unclear. In particular, the role of trace elements in mental illness is still matter of debate. Here, we investigated whether trace elements are correlated to specific psychopathological phenotype groups. METHODS: Axis I and II disorders, aggression, impulsivity, adult attention deficit/hyperactivity disorders (ADHD) indices and serum levels of zinc, copper and cadmium were evaluated in 160 male prisoners. RESULTS: Using latent class analysis we could subdivide prisoners into three distinct psychopathological classes: Class 1 characterized by low prevalence of aggression, personality disorders and substance abuse/dependence (alcohol, cannabis, cocaine); Class 2 represented by low prevalence of aggression and high prevalence of personality disorders and substance abuse/dependence; Class 3 defined by high prevalence of aggression, personality disorders and substance abuse/dependence. Serum levels of zinc were higher in Class 2 and 3 compared to Class 1. Moreover, Class 3 was associated with higher scores of impulsivity and ADHD indices. CONCLUSION: Our results suggest that impulsivity but also adult ADHD indices are related to aggressive behaviour, and higher zinc levels are linked to personality disorders and addictions, but not to aggression.

Distinct pathological profiles of inmates showcasing cluster B personality traits, mental disorders and substance use regarding violent behaviors.

High rates of violence are found amid offenders with severe mental illnesses (SMI), substance use disorders (SUDs) and Cluster B personality disorders. Elevated rates of comorbidity lead to inconsistencies when it comes to this relationship. Furthermore, overlapping Cluster B personality traits have been associated with violence. Using multiple correspondence analysis and cluster analysis, this study was designed to differentiate profiles of 728 male inmates from penitentiary and psychiatric settings marked by personality traits, SMI and SUDs following different violent patterns. Six significantly differing clusters emerged. Cluster 1, "Sensation seekers", presented recklessness with SUDs and low prevalence's of SMI and auto-aggression. Two clusters committed more sexual offenses. While Cluster 2, "Opportunistic-sexual offenders", had more antisocial lifestyles and SUDs, Cluster 6, "Emotional-sexual offenders", displayed more emotional disturbances with SMI and violence. Clusters 3 and 4, representing "Life-course-persistent offenders", shared early signs of persistent antisocial conduct and severe violence. Cluster 3, "Early-onset violent delinquents", emerged as more severely antisocial with SUDs. Cluster 4, "Early-onset unstable-mentally ill delinquents", were more emotionally driven, with SMI and auto-aggression. Cluster 5, "Late-start offenders", was less severely violent, and emotionally driven with antisocial behavior beginning later. This study suggests the presence of specific psychopathological organizations in violent inmates.

Nonfatal suicide-related behavior among inmates: testing for gender and type differences.

Suicide-related behavior (SRB) is significantly more prevalent among female (40.8%) than among male (28%) inmates, although suicide risk is higher among the latter. When instrumental behavior (IB) is excluded and only suicidal acts (SA) considered, rates for the two groups are more comparable (11.9% and 16%, respectively). Compared with other female inmates, the SRB group is more suicidal, hostile, and impulsive and more likely to have been previously victimized and to be diagnosed with Axis I and II disorders. Women with IB are not significantly different from those with SA, except that their behavior provides significantly greater tension release.

Further evidence of the validity of the Suicide Risk Assessment Scale for prisoners.

The Suicide Risk Assessment Scale (SRAS; nine items) is useful in correctional settings but needed further validation. First, 44 inmates originally screened as suicidal with the SRAS were evaluated by institutional psychologists according to five criteria: suicidal urgency, risk, appropriateness of referral, need for short- or long-term watch. On the whole, the SRAS was judged to be as effective as a more elaborate test. Second, 242 suicidal and non-suicidal inmates were tested with the SRAS. Their results correlated better with suicidal risk (.71) than with urgency (.50). Receiver operating characteristic (ROC) analysis even showed that the SRAS performed better than a more elaborate test in predicting risk.

Tryptophan via serotonin/kynurenine pathways abnormalities in a large cohort of aggressive inmates: markers for aggression.

Aggressive behavior is one of the most challenging symptoms in psychiatry, and biological markers for aggression lack of large sample validations. Serotonin (5-HT) and other neuroactive compounds deriving from Tryptophan (Trp), including kynurenine (Kyn), have not yet been investigated in large cohorts of aggressive individuals to validate their potential as biomarkers of aggression. In 361 male inmates we measured serum levels of Trp, 5-hydroxytryptophan, 5-HT, Kyn, the ratios 5-HT/Trp∗1000 and Kyn/Trp∗1000, and performed Structured Clinical Interview for DSM-IV Axis-I and -II Disorders (SCID-I and -II), global assessment of functioning (GAF), and scales for aggressive behavior, impulsivity, adult attention-deficit/hyperactivity disorder (ADHD), and intelligent quotient (IQ). Aggressive compared to non-aggressive inmates exhibited lower Trp and Kyn serum levels but higher levels of 5-HT and 5-HT/Trp∗1000, higher levels of impulsivity and ADHD indices, lower IQ and GAF, higher prevalence of mood disorders, drug abuse/dependence, and borderline, conduct and antisocial behaviors. Interestingly, Kyn/Trp∗1000 was positively correlated to the number of severe aggressive acts (r=0.593, P<0.001). After adjusting for confounding factors, logistic regression analysis indicated that 5-HT/Trp∗1000, antisocial behavior, and GAF were predictors of aggressive behavior. The model combining these three predictors had an area under the ROC curve of 0.851 (95% CI 0.806-0.895). This study indicates that while circulating Trp is reduced in aggressive individuals, the combination of biological (5-HT/Trp ratio) and psychopathological (antisocial behavior and GAF) markers discriminates between aggressive and non-aggressive behavior suggesting the potential of a multi-marker approach in psychiatry given the heterogenic nature of mental diseases.

The national trajectory project of individuals found not criminally responsible on account of mental disorder in Canada. Part 1: context and methods.

The National Trajectory Project examined longitudinal data from a large sample of people found not criminally responsible on account of mental disorder (NCRMD) to assess the presence of provincial differences in the application of the law, to examine the characteristics of people with serious mental illness who come into conflict with the law and receive this verdict, and to investigate the trajectories of NCRMD-accused people as they traverse the mental health and criminal justice systems. Our paper describes the rationale for the National Trajectory Project and the methods used to collect data in Quebec, Ontario, and British Columbia, the 3 most populous provinces in Canada and the 3 provinces with the most people found NCRMD.

The national trajectory project of individuals found not criminally responsible on account of mental disorder in Canada. Part 2: the people behind the label.

OBJECTIVE: To examine the psychosocio-criminological characteristics of not criminally responsible on account of mental disorder (NCRMD)-accused people and compare them across the 3 most populous provinces. In Canada, the number of people found NCRMD has risen during the past 20 years. The Criminal Code is federally legislated but provincially administered, and mental health services are provincially governed. Our study offers a rare opportunity to observe the characteristics and trajectories of NCRMD-accused people. METHOD: The National Trajectory Project examined 1800 men and women found NCRMD in British Columbia (n = 222), Quebec (n = 1094), and Ontario (n = 484) between May 2000 to April 2005, followed until December 2008. RESULTS: The most common primary diagnosis was a psychotic spectrum disorder. One-third of NCRMD-accused people had a severe mental illness and a concomitant substance use disorder, with British Columbia having the highest rate of dually diagnosed NCRMD-accused people. Most accused people (72.4%) had at least 1 prior psychiatric hospitalization. Two-thirds of index NCRMD offences were against the person, with a wide range of severity. Family members, followed by professionals, such as police and mental health care workers, were the most frequent victims. Quebec had the highest proportion of people with a mood disorder and the lowest median offence severity. There were both interprovincial differences and similarities in the characteristics of NCRMD-accused people. CONCLUSIONS: Contrary to public perception, severe violent offenses such as murder, attempted murder or sexual offences represent a small proportion of all NCRMD verdict offences. The results reveal a heterogeneous population regarding mental health and criminological characteristics in need of hierarchically organized forensic mental health services and levels of security. NCRMD-accused people were well known to civil psychiatric services prior to being found NCRMD. Risk assessment training and interventions to reduce violence and criminality should be a priority in civil mental health services.

The national trajectory project of individuals found not criminally responsible on account of mental disorder in Canada. Part 3: trajectories and outcomes through the forensic system.

OBJECTIVE: To examine the processing and Review Board (RB) disposition outcomes of people found not criminally responsible on account of mental disorder (NCRMD) across the 3 most populous provinces in Canada. Although the Criminal Code is federally legislated, criminal justice is administered by provinces and territories. It follows that a person with mental illness who comes into conflict with the law and subsequently comes under the management of a legally mandated RB may experience different trajectories across jurisdictions. METHOD: The National Trajectory Project examined 1800 men and women found NCRMD in British Columbia (n = 222), Quebec (n = 1094), and Ontario (n = 484) between May 2000 and April 2005, followed until December 2008. RESULTS: We found significant interprovincial differences in the trajectories of people found NCRMD, including time detained in hospital and time under the supervision of an RB. The odds of being conditionally or absolutely discharged by the RB varied across provinces, even after number of past offences, diagnosis at verdict, and most severe index offence (all covariates decreased likelihood of discharge) were considered. CONCLUSIONS: Considerable discrepancies in the application of NCRMD legislation and the processing of NCRMD cases through the forensic system across the provinces suggests that fair and equitable treatment under the law could be enhanced by increased national integration and collaboration.

The national trajectory project of individuals found not criminally responsible on account of mental disorder. Part 5: how essential are gender-specific forensic psychiatric services?

OBJECTIVE: To state the sociodemographic characteristics, mental health histories, index offence characteristics, and criminal histories of male and female forensic psychiatric patients. Clinicians and researchers advocate that mental health and criminal justice organizations implement gender-specific services; however, few studies have sampled forensic patients to evaluate the extent to which men's and women's treatment and management needs are different. METHOD: Data were collected from Review Board files from May 2000 to April 2005 in the 3 largest Canadian provinces. Using official criminal records, participants were followed for 3 to 8 years, until December 2008. The final sample comprised 1800 individuals: 15.6% were women and 84.4% were men. RESULTS: There were few demographic differences, but women had higher psychosocial functioning than men. Both men and women had extensive mental health histories; women were more likely diagnosed with mood disorders and PDs and men were more likely diagnosed with schizophrenia spectrum disorders and SUDs. The nature of the index offence did not differ by gender, except women were more likely to have perpetrated murders and attempted murders. For offences against a person, women were more likely to offend against offspring and partners and less likely to offend against strangers, compared with men. Women had significantly less extensive criminal histories than men. CONCLUSIONS: Not criminally responsible on account of mental disorder-accused women have a distinct psychosocial, clinical, and criminological profile from their male counterparts, which may suggest gender-specific assessment, risk management, and treatment in forensic services could benefit patients. The findings are also consistent with traditional models (Risk-Need-Responsivity) and ultimately demonstrate the importance of individual assessment and client-centred services.