Hypothalamic subunit volumes and relations to violence and psychopathy in male offenders with or without a psychotic disorder.

The hypothalamus is key to body homeostasis, including regulating cortisol, testosterone, vasopressin, and oxytocin hormones, modulating aggressive behavior. Animal studies have linked the morphology and function of the hypothalamus to aggression and affiliation, with a subregional pattern reflecting the functional division between the hypothalamic nuclei. We explored the relationship between hypothalamic subunit volumes in violent offenders with (PSY-V) and without (NPV) a psychotic disorder, and the association with psychopathy traits. 3T MRI scans (n = 628, all male 18-70 years) were obtained from PSY-V, n = 38, NPV, n = 20, non-violent psychosis patients (PSY-NV), n = 134, and healthy controls (HC), n = 436. The total hypothalamus volume and its eleven nuclei were delineated into five subunits using Freesurfer v7.3. Psychopathy traits were assessed with Psychopathy Checklist-revised (PCL-R). ANCOVAs and linear regressions were used to analyze associations with subunit volumes. Both groups with a history of violence exhibited smaller anterior-superior subunit volumes than HC (NPV Cohen's d = 0.56, p = 0.01 and PSY-V d = 0.38, p = 0.01). There were no significant differences between HC and PSY-NV. PCL-R scores were positively associated with the inferior tubular subunit on a trend level (uncorrected p = 0.045, Cohen's d = 0.04). We found distinct hypothalamic subunit volume reductions in persons with a history of violence independent of concomitant psychotic disorder but not in persons with psychosis alone. The results provide further information about the involvement of the hypothalamus in aggression, which ultimately may lead to the development of targeted treatment for the clinical and societal challenge of aggression and violent behavior.

Common genetic and environmental risk for personality disorders and psychotic-like experiences in young adult twins.

INTRODUCTION: Psychotic-like experiences (PLE) have been associated with the subsequent emergence of psychotic disorders as well as several other domains of psychopathology. In this twin study, we estimated the genetic and environmental correlations between PLE and 10 personality disorders (PD). METHODS: Diagnoses of 10 PDs according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and PLE from the Composite International Diagnostic Interview (CIDI) were retrieved for 2793 young adult twins from the Norwegian Twin Registry. Risk for having a PD and PLEs was modeled using item response theory. Biometric twin models were fitted to estimate the genetic and environmental correlations between PDs and PLEs. Co-twin control analysis was performed to estimate additional within-family risk for PLEs when having a PD. RESULTS: Phenotypic overlap between PDs and PLEs ranged from 14% to 44% in males and from 11% to 39% in females, with the highest overlap for borderline PD in both sexes. In general, we found higher genetic correlations (r = 0.14-0.72) than environmental correlations (r = 0.06-0.28) between PDs and PLEs. The highest genetic correlations between PLE and PDs were found for borderline (r = 0.72), paranoid (r = 0.56), schizotypal (r = 0.56) and antisocial PD (r = 0.49). CONCLUSION: We found that the co-occurrence between PDs and PLE is the best explained by shared genetic determinants, with minor contributions from environmental factors. Interestingly, borderline PD was highly genetically correlated with PLE, warranting molecular genetic studies of this association.

Psychopathy subdomains in violent offenders with and without a psychotic disorder.

BACKGROUND: Violence in psychosis has been linked to antisocial behavior and psychopathy traits. Psychopathy comprises aspects of interpersonal, affective, lifestyle, and antisocial traits which may be differently involved in violent offending by persons with psychotic disorders. We explored psychopathy subdomains among violent offenders with and without a psychotic disorder. METHODS: 46 males, with a history of severe violence, with (n = 26; age 35.85 ± 10.34 years) or without (n = 20; age 39.10 ± 11.63 years) a diagnosis of a psychotic disorder, were assessed with the Psychopathy Checklist-Revised (PCL-R). PCL-R was split into subdomains following the four-facet model. Group differences in total and subdomain scores were analyzed with a general linear model with covariates. RESULTS: Total PCL-R scores did not differ between the groups (p = 0.61, Cohen's d = 0.17). The violent offenders without psychotic disorders had higher facet 2 scores than the patient group with psychotic disorders (p = 0.029, Cohen's d = 0.77). Facet 1, 3, or 4 scores did not differ between the groups. Controlling for age did not alter the results. CONCLUSION: Patients with a psychotic disorder and a history of severe violence have lower affective psychopathy scores than violent offenders without psychotic disorders. This observation may point toward distinct underlying mechanisms for violence and may provide a target for focused treatment and prevention.

Testing the Static-99R as a Global Screen for Risk of Sex Crime Recidivism in a Norwegian Routine Sample.

The Static-99R has been recommended for use as a first global screen for sorting out sex-convicted persons who are in need of further risk assessment. This study investigated the Static-99R's predictive validity based on a nonselected Norwegian sample (n = 858) of persons released from prison after having served a sex crime sentence. After a mean observation period of 2,183 days, 3.4% (n = 29) had recidivated to a new sex offense. A higher number of recidivists were found among those with higher Static-99R total scores. The predictive contribution from each of the ten Static-99R risk items was investigated using standard logistic regression, proportional hazard regression, and random forest classification algorithm. The overall results indicate that the Static-99R is relevant as a risk screen in a Norwegian context, providing similar results concerning predictive accuracy as previous studies.

An exploration of theory of mind performance among men convicted of rape.

Several of the known risk factors for sexual violence concern a lack of capacity for engaging in mutually satisfying interpersonal relationships. Socio-cognitive deficits may be approached from a theory of mind (ToM) perspective, where lack of ability to attribute mental states to others is seen as the core feature. This study focuses on imprisoned men (n = 26) convicted of rape against an adult. A video-based measure of ToM (MASC) was applied, depicting social interaction in a dynamic real-life setting. The results showed that the rape-convicted men have a markedly inferior ability to infer the mental states of others. Clinical as well as theoretical implications of the findings are discussed.

Stalking experiences and associated factors--a controlled population-based study from Norway.

BACKGROUND: Stalking is a considerable health problem. In order to develop interventions for victims, more knowledge is needed concerning prevalence, stress and coping related to stalking as well as associated symptomatology in the victims. This is the first population-based study of stalking in Norway. AIMS: To examine the prevalence of stalking in relation to gender and time, and the association with indicators of socio-demographic status and mental health. METHODS: A cross-sectional case-control questionnaire design. The sample, 5000 Norwegians aged 20-59 years, was nationally representative according to gender, 10-year age groups and county of living. A total of 248 (5%) of the mailed envelops were returned due to wrong address, leaving 4752 individuals as possible respondents. Among them 1520 (32%) returned the questionnaire, but 98 of them had to be discarded due to lack of completion, giving a sample of 1422 valid questionnaires (30%). RESULTS: The total weighted lifetime prevalence of stalking was 8.1% (95% CI 6.6-9.4%), for females 11.8% (95% CI 10.2-13.5%) and for males 4.3% (95% CI 3.2-5.3%) [corrected]. The point prevalence of current stalking was 2.8% (95% CI 2.0-3.7%). The stalked individuals had a significantly poorer social situation and mental health than the controls. Few significant group differences were observed between males and females exposed to stalking. CONCLUSIONS: The prevalence of stalking was within the range observed by questionnaire studies in other cultures.

Conduct disorder - a comprehensive exploration of comorbidity patterns, genetic and environmental risk factors.

Conduct disorder (CD), a common mental disorder in children and adolescents, is characterized by antisocial behavior. Despite similarities with antisocial personality disorder (ASPD) and possible diagnostic continuity, CD has been shown to precede a range of adult-onset mental disorders. Additionally, little is known about the putative shared genetic liability between CD and adult-onset mental disorders and the underlying gene-environment interplay. Here, we interrogated comorbidity between CD and other mental disorders from the Norwegian Mother, Father and Child Cohort Study (n = 114 500) and investigated how polygenic risk scores (PRS) for mental health traits were associated with CD/CD traits in childhood and adolescence. Gene-environment interplay patterns for CD was explored with data on bullying and parental education. We found CD to be comorbid with several child and adult-onset mental disorders. This phenotypic overlap corresponded with associations between PRS for mental disorders and CD. Additionally, our findings support an additive gene-environment model. Previously conceptualized as a precursor of ASPD, we found that CD was associated with polygenic risk for several child- and adult-onset mental disorders. High comorbidity of CD with other psychiatric disorders reflected on the genetic level should inform research studies, diagnostic assessments and clinical follow-up of this heterogenous group.

Prevalence and characteristics of mental and physical disorders among female prisoners: a mixed-methods systematic review.

PURPOSE: This study aims to provide an overview and quality appraisal of the current scientific evidence concerning the prevalence and characteristics of mental and physical disorders among sentenced female prisoners. DESIGN/METHODOLOGY/APPROACH: A mixed-methods systematic literature review. FINDINGS: A total of 4 reviews and 39 single studies met the inclusion criteria for the review. Mental disorders were the main area of investigation in the majority of single studies, with substance abuse, particularly drug abuse, as the most consistently gender biased disorder, with higher prevalence among women than men in prison. The review identified a lack of updated systematic evidence on the presence of multi-morbidity. ORIGINALITY/VALUE: This study provides an up-to-date overview and quality appraisal of the current scientific evidence concerning the prevalence and characteristics of mental and physical disorders among female prisoners.

Violent Offending in Males With or Without Schizophrenia: A Role for Social Cognition?

BACKGROUND AND HYPOTHESIS: Reduced social cognition has been reported in individuals who have committed interpersonal violence. It is unclear if individuals with schizophrenia and a history of violence have larger impairments than violent individuals without psychosis and non-violent individuals with schizophrenia. We examined social cognition in two groups with violent offenses, comparing their performance to non-violent individuals with schizophrenia and healthy controls. STUDY DESIGN: Two social cognitive domains were assessed in four groups: men with a schizophrenia spectrum disorder with (SSD-V, n = 27) or without (SSD-NV, n = 42) a history of violence, incarcerated men serving preventive detention sentences (V, n = 22), and healthy male controls (HC, n = 76). Theory of mind (ToM) was measured with the Movie for the Assessment of Social Cognition (MASC), body emotion perception with Emotion in Biological Motion (EmoBio) test. STUDY RESULTS: Kruskal-Wallis H-tests revealed overall group differences for social cognition. SSD-V had a global and clinically significant social cognitive impairment. V had a specific impairment, for ToM. Binary logistic regressions predicting violence category membership from social cognition and psychosis (SSD status) were conducted. The model with best fit, explaining 18%-25% of the variance, had ToM as the only predictor. CONCLUSIONS: Social cognitive impairment was present in individuals with a history of violence, with larger and more widespread impairment seen in schizophrenia. ToM predicted violence category membership, psychosis did not. The results suggest a role for social cognition in understanding interpersonal violence.

Intimate Partner Homicides in Norway 1990-2020: An Analysis of Incidence and Characteristics.

Intimate partner homicide (IPH) is an extreme outcome of intimate partner violence (IPV). It is a societal challenge that needs to be investigated over time to see whether changes occur concerning the incidence of IPH, IPH characteristics, socioeconomic factors, and contact with service providers. This study includes the total Norwegian cohort of IPHs between 1990 and 2019 with a final conviction (N = 224). Poisson regression was applied to model the incidence rate of homicide and IPH between 1990 and 2020 as well as the incidence rates of immigrant perpetrators and victims. Multivariate logistic regression analyses were used to test the association between characteristics and period 1990-2012 compared to after 2012 as dependent variable. The results show that though homicide incidence rates in Norway declined steadily and significantly after 1990, IPH rates did not begin to decline until 2015. The following IPH characteristics showed reduced incidence after 2012: IPH-suicide, perpetrators with a criminal record, and IPHs perpetrated subsequent to preventive interventions towards the perpetrator. Sentence length in IPH cases had increased. Changes were not observed for any of the other IPH characteristics investigated. IPH is often the culmination of long-term violence and can be prevented, even if risk assessment is challenging due to the low base rates.

Associations between amygdala nuclei volumes, psychosis, psychopathy, and violent offending.

The amygdala is involved in fear perception and aggression regulation, and smaller volumes have been associated with psychotic and non-psychotic violence. We explored the relationship between amygdala nuclei volumes in violent offenders with and without psychosis, and the association to psychopathy traits. 3T MRI scans (n = 204, males, 18-66 years) were obtained from psychotic violent offenders (PSY-V, n = 29), non-psychotic violent offenders (NPV, n = 19), non-violent psychosis patients (PSY-NV, n = 67), and healthy controls (HC, n = 89). Total amygdala and 9 amygdala nuclei volumes were obtained with FreeSurfer. Psychopathy traits were measured with the Psychopathy Checklist-revised (PCL-R). Multivariate analyses explored diagnostic differences in amygdala nuclei volumes and associations to psychosis, violence, and psychopathy traits. PSY-V had a smaller basal nucleus, anterior amygdaloid area, and cortical amygdalar transition area (CATA), whereas PSY-NV had a smaller CATA than HC. Volumes in NPV did not differ from HC, and there were no associations between PCL-R total or factor scores and any of the nuclei or whole amygdala volumes. The lower volumes of amygdala nuclei involved in fear modulation, stress responses, and social interpretation may point towards some mechanisms of relevance to violence in psychosis, but the results warrant replication in larger subject samples.

The age of violence: Mapping brain age in psychosis and psychopathy.

Young chronological age is one of the strongest predictors for antisocial behaviour in the general population and for violent offending in individuals with psychotic disorders. An individual's age can be predicted with high accuracy using neuroimaging and machine-learning. The deviation between predicted and chronological age, i.e., brain age gap (BAG) has been suggested to reflect brain health, likely relating partly to neurodevelopmental and aging-related processes and specific disease mechanisms. Higher BAG has been demonstrated in patients with psychotic disorders. However, little is known about the brain-age in violent offenders with psychosis and the possible associations with psychopathy traits. We estimated brain-age in 782 male individuals using T1-weighted MRI scans. Three machine learning models (random forest, extreme gradient boosting with and without hyper parameter tuning) were first trained and tested on healthy controls (HC, n = 586). The obtained BAGs were compared between HC and age matched violent offenders with psychosis (PSY-V, n = 38), violent offenders without psychosis (NPV, n = 20) and non-violent psychosis patients (PSY-NV, n = 138). We ran additional comparisons between BAG of PSY-V and PSY-NV and associations with Positive and Negative Syndrome Scale (PANSS) total score as a measure of psychosis symptoms. Psychopathy traits in the violence groups were assessed with Psychopathy Checklist-revised (PCL-R) and investigated for associations with BAG. We found significantly higher BAG in PSY-V compared with HC (4.9 years, Cohen'sd = 0.87) and in PSY-NV compared with HC (2.7 years, d = 0.41). Total PCL-R scores were negatively associated with BAG in the violence groups (d = 1.17, p < 0.05). Additionally, there was a positive association between psychosis symptoms and BAG in the psychosis groups (d = 1.12, p < 0.05). While the significant BAG differences related to psychosis and not violence suggest larger BAG for psychosis, the negative associations between BAG and psychopathy suggest a complex interplay with psychopathy traits. This proof-of-concept application of brain age prediction in severe mental disorders with a history of violence and psychopathy traits should be tested and replicated in larger samples.

PriSUD-Nordic-Diagnosing and Treating Substance Use Disorders in the Prison Population: Protocol for a Mixed Methods Study.

BACKGROUND: A large proportion of the prison population experiences substance use disorders (SUDs), which are associated with poor physical and mental health, social marginalization, and economic disadvantage. Despite the global situation characterized by the incarceration of large numbers of people with SUD and the health problems associated with SUD, people in prison are underrepresented in public health research. OBJECTIVE: The overall objective of the PriSUD (Diagnosing and Treating Substance Use Disorders in Prison)-Nordic project is to develop new knowledge that will contribute to better mental and physical health, improved quality of life, and better life expectancies among people with SUD in prison. METHODS: PriSUD-Nordic is based on a multidisciplinary mixed method approach, including the methodological perspectives of both quantitative and qualitative methods. The qualitative part includes ethnographic fieldwork and semistructured interviews. The quantitative part is a registry-based cohort study including national registry data from Norway, Denmark, and Sweden. The national prison cohorts will comprise approximately 500,000 individuals and include all people imprisoned in Norway, Sweden, and Demark during the period from 2000 to 2019. The project will investigate the prison population during three different time periods: before imprisonment, during imprisonment, and after release. RESULTS: PriSUD-Nordic was funded by The Research Council of Norway in December 2019, and funding started in 2020. Data collection is ongoing and will be completed in the first quarter of 2022. Data will be analyzed in spring 2022 and the results will be disseminated in 2022-2023. The PriSUD-Nordic project has formal ethical approval related to all work packages. CONCLUSIONS: PriSUD-Nordic will be the first research project to investigate the epidemiology and the lived experiences of people with SUD in the Nordic prison population. Successful research in this field will have the potential to identify significant areas of benefit and will have important implications for ongoing policy related to interventions for SUD in the prison population. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/35182.

A Comparison of Intimate Partner Homicide With Intimate Partner Homicide-Suicide: Evidence From a Norwegian National 22-Year Cohort.

Homicide-suicide incidents make up a relatively small proportion of homicides overall, but occur more frequently in certain subtypes of homicide, such as men who kill their female partners. This study investigates aspects of intimate partner homicide-suicide (IPHS) by comparing it with intimate partner homicide (IPH). All IPHs in Norway from 1990 to 2012 (N = 177) were included. Quantitative data were extracted from court documents. Qualitative data were collected by interviews with bereaved. Multivariate logistic regression analyses and systematic text condensation were conducted. Nearly one fourth of IPHs were identified as IPHS. Perpetrators of IPHS were less likely to have a previous criminal record, even having a history of disregard and violations of the law. Perpetrators of IPHS were mainly native-born citizens and were more educated than IPH perpetrators. The motive of IPHS was more often jealousy than a dispute, but the motive was most often recorded as "other" or "unknown." IPHS was perceived as intentional, and the bereaved did not unambiguously support the interpretation that the IPHS had been triggered by stressful situations. The bereaved pointed to the loss of hope or loss of a future combined with an inability to cope with severe disappointments as an important risk factor. Within the framework of an interactional perspective, our findings indicate that IPHS shares more characteristics with IPH than it does with other categories of homicide and other violent deaths in general.

Socio-economic status and health in a marginalized group: the role of subjective social status among prison inmates.

BACKGROUND: One problem in studies of social inequality in health is that traditional socio-economic indicators are unsuitable for groups finding themselves on the outside of those societal arenas from which measures of education, income and occupation are generated. A measure of subjective social position has accordingly been proposed as an addition to the traditional objective socio-economic measures. The present study investigates this concepts' usefulness as an addition to objective SES markers in a sample of prison inmates, known for their marginalized position in society as well as their poor health. METHODS: Analyses are based on the male part (n = 225) of a nationally representative sample of prison inmates in Norway. Outcome measures are self-rated health, long-standing illness or disability, mental health problems, perceived change in health status and drug use. Analyses of correlation as well as multivariate logistic regression analyses were performed. RESULTS: Subjective social status was bivariately related to all of the health outcomes, except long-standing illness. Multivariate analyses indicated that subjective social status influenced the odds of experiencing mental health problems, but not any of the other health outcomes when controlling for the other independent variables. CONCLUSION: Subjective social status may add important information to our understanding of the relationship between social disadvantage and mental health in a marginalized social group such as prison inmates.

Childhood Trauma in Persons With Schizophrenia and a History of Interpersonal Violence.

BACKGROUND: Childhood trauma is a risk factor for psychosis as well for violent behavior and offending later in life. Childhood trauma comprises subdomains of abuse and neglect that may be differently related to later violence among patients with schizophrenia. The aim of this study was to map the subdomains of childhood trauma associated with violent offending in schizophrenia. METHODS: Information on childhood trauma from predominantly male patients with a DSM-IV diagnosis of schizophrenia and a history of violent offending (interpersonal violence) (SCZ-V, n = 19), schizophrenia patients without a history of violence (SCZ-NV, n = 34), and healthy controls (HC, n = 66) was obtained with the Childhood Trauma Questionnaire (CTQ). Differences between groups in total maltreatment scores and the five subdomains including physical, emotional, and sexual abuse, as well as physical and emotional neglect were analyzed. RESULTS: SCZ-V had the highest median CTQ scores for all sub-domains. SCZ-V reported significantly higher total CTQ scores than SCZ-NV and HC. SCZ-V had significantly higher scores than HC on all subdomains, and significantly higher than SCZ-NV on physical and emotional neglect. SCZ-NV had higher scores on all domains except sexual abuse compared to HC. CONCLUSION: SCZ-V patients had higher exposure to childhood trauma than SCZ-NV, and both schizophrenia groups had higher exposure than HC. The results suggest that childhood physical and emotional neglect may be of specific importance to later violence in schizophrenia.

Drug use and mental health problems among prison inmates--results from a nation-wide prison population study.

Prisons all over the western world are known to be inhabited by a biased sample of the population. More information is needed on how problems in diverse areas interact. The present study investigated how general welfare deficiencies, drug use and mental health problems were related in a representative prison population. Data stem from a level-of-living survey among a nationwide representative sample of Norwegian prison inmates. The sample was drawn randomly from the official register of prison inmates. Data were collected through structured personal interviews (computer assisted). Analyses presented in this paper are based on the male part of the sample (n=225). Only 24% of male prisoners were affected by neither drug use problems nor mental health problems. Investigating the relationship between variables indicated an increasing accumulation of childhood stressors and general welfare deficiencies with increasing drug use and mental health problems. As health problems are intertwined with more general social problems, health promotion among prison inmates is clearly a multidisciplinary task, requiring close collaboration between different service providers and systems of care.

Social adversities in first-time and repeat prisoners.

AIMS: To explore possible systematic differences between prison inmates serving their first sentence and inmates having experienced previous incarcerations. It is hoped that a better knowledge of these issues will make us better equipped to meet the rehabilitation needs of our prisoners and decrease their risk of reoffending and reincarceration. METHODS: In this cross-sectional study a randomly selected and nationally representative sample of 260 Norwegian prisoners, 100 serving their first sentence and 160 recidivists, was interviewed with special focus on childhood circumstances, education, work experience, and present social and economic situation. In addition their criminal records were collected from the National Crime Registry. RESULTS: In males multivariate analyses identified a number of variables independently and significantly associated with being a repeat offender. The odds for reincarceration increased significantly if the person fulfilled any one of the following criteria: having experienced the incarceration of a family member during childhood (OR = 3.6); having experienced childcare interventions during childhood (OR = 3.2); current drug abuse (OR = 2.6); current housing problems (OR = 2.3). In females only one strong correlation emerged: if the person had current drug problems the odds for being a recidivist increased substantially (OR = 10.9). CONCLUSIONS: While criminal reoffending and reincarceration seemed to be primarily associated with drug abuse in females, the childhood problems of male repeat offenders, compared with males serving their first sentence, indicate that these individuals' current multiple social and economic disadvantages were complex in origin and of long standing. Interventions aimed at preventing reoffending must take into account the gender differences demonstrated. AIM: ing at primary prevention, the negative effects associated with parental incarceration are crucial: how can one prevent the perpetuation of these problems from one generation to the next?

Socioeconomic patterning of smoking, sedentary lifestyle, and overweight status among adolescents in Norway and the United States.

Increased efforts are needed to promote adolescent health in all areas investigated in this study. Differences both in prevalence and socioeconomic patterning between Norway and the United States indicate that the major challenges differ between the two countries. The results also emphasize the need to undertake joint efforts to use measurements that make national data sets comparable across countries.

Adverse childhood experiences among women prisoners: relationships to suicide attempts and drug abuse.

BACKGROUND: Women prisoners are known to suffer from an accumulation of factors known to increase the risk for several major health problems. This study examines the prevalence of adverse childhood experiences (ACE) and the relationship between such experiences and suicide attempts and drug use among incarcerated women in Norway. METHODS: A total of 141 women inmates (75% of all eligible) were interviewed using a structured interview guide covering information on demographics and a range of ACE related to abuse and neglect, and household dysfunction. The main outcome variables were attempted suicide and adult drug abuse. RESULTS: Emotional, physical and sexual abuse during childhood was experienced by 39%, 36% and 19%, respectively, and emotional and physical neglect by 31% and 33%, respectively. Looking at the full range of ACE, 17% reported having experienced none, while 34% reported having experienced more than five ACEs. After controlling for age, immigrant background and marital status, the number of ACEs significantly increased the risk of attempted suicide and current drug abuse. CONCLUSION: The associations observed between early life trauma and later health risk behaviour indicate the need for early prevention. The findings also emphasize the important role of prison health services in secondary prevention among women inmates.