Psychopathology and history of mental healthcare among male detainees transferred to a facility for managing otherwise uncontrollable in-prison violence: An exploratory study.

BACKGROUND: In-prison violence by detainees is a problem worldwide, but despite evidence of a much higher prevalence of a range of psychiatric disorders than in the general population, little is known about psychopathology among violent detainees. AIMS: Our aim was to explore the psychopathology and mental healthcare history of Dutch detainees who were transferred to the highly restrictive facility for uncontrollably violent detainees following severe in-prison violence. METHODS: Anonymised data for all 253 male detainees incarcerated at any time between January 2016 and January 2020 in the specialist national facility for those seriously violent while in prison-'the Violence Facility'-were obtained from the Dutch Ministry of Justice together with similarly recorded data for a matched comparison group of 253 detainees admitted to an in-prison psychiatric facility-'the Psychiatric Facility'. RESULTS: There was no record of any psychiatric assessment for 29% of the Violence Facility men. Almost all of the detainees who had been assessed were classified with at least one disorder. Compared to detainees in the Psychiatric Facility, Violence Facility men were more likely to be diagnosed with attention deficit hyperactivity disorder (ADHD), anxiety, behavioural and personality disorders; Psychiatric Facility men were more likely to be diagnosed with psychosis or substance use disorder. Most men in both groups had previously used mental health services. CONCLUSIONS: This first study of detainees in the Dutch in-prison facility for violent detainees raises questions about whether the extent of violence among these men may have masked mental healthcare needs and leads to questions about potential benefits from establishing more systematic mental health assessments for them, and a need for more specialist services.

Men and women with borderline personality disorder resident in Dutch special psychiatric units in prisons: A descriptive and comparative study.

BACKGROUND: The overall prevalence of borderline personality disorder is well known, but characteristics of offender patients with the condition are less clear, especially among men. AIM: Describe characteristics of men and women with borderline personality disorder in special psychiatric units in Dutch prisons on three domains: prevalence of child abuse, comorbidity of borderline personality disorder with other disorders, and clinical symptoms. METHODS: One hundred and sixty-seven people were assigned to this study based on a Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) diagnoses retrieved from records. Other DSM-5 diagnoses were also recorded. Two scales, the Dutch Historisch, Klinisch, Toekomst-Revisie and the international Brief Psychiatric Rating Scale-Expanded (BPRS-E) were used to record child abuse and clinical symptoms, respectively. RESULTS: Prevalence rates of child abuse were high, but the men and women did not differ in this respect. The male offender patients were more likely than the women to have a comorbid substance use disorder, whereas the women were more likely to have a comorbid anxiety disorder. Intellectual disability was the most common comorbid Axis II disorder. The women were more likely than the men to have committed a fatal/nearly fatal index offence and showed higher rates of distress or behavioural disturbance on all five BPRS-E factors. CONCLUSIONS: This study provides evidence of the importance of in-depth knowledge of presentations with borderline personality disorder specific to setting. Although we were unable to make direct comparisons with other samples, our figures suggest clinically relevant differences among offender patients from the more widely reported general samples. We also shed light on a sometimes underexposed group of men with borderline personality disorder and their clinical needs. More population-specific intervention and follow-up studies are now indicated.

Characteristics of forensic psychiatric patients with a neurocognitive disorder.

BACKGROUND: 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. AIMS: To gain knowledge on the prevalence and characteristics of individuals with neurocognitive disorders in the forensic population. METHOD: 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. RESULTS: 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. CONCLUSIONS: 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.

Prison and the brain.

Imprisonment is a common punishment in most countries. Goals of imprisonment are often not only retribution, but also prevention. Specific prevention aims to reduce the risk of reoffending of the imprisoned offender. The question is whether the goals of retribution and specific prevention contradict each other. Retribution is not only expressed in taking away ones freedom, but also in the prison environment itself. Prisoners live in a sober regime, with a minimal amount of autonomy. There are few cognitive challenges, meaningful social interaction is reduced significantly, and many prisoners are highly sedentary. In other words, prison can be viewed as an impoverished environment. In the last few decades, much knowledge has been gained on the influence of enriched versus impoverished environment on the brain. In this chapter, we discuss the influence of the impoverished prison environment on brain functions of prisoners, with an emphasis on self-regulation and executive functions, since these functions are (1) often impaired in offenders, (2) highly sensitive to environmental influences, and (3) crucial for successful resocialization. We conclude this chapter by discussing possibilities for and potential effects of enriching prison environments.

Aggressive Incidents by Incarcerated People With Psychiatric Illness and Their Relationship With Psychiatric Symptoms.

AIM: A prospective design was used to investigate the relationship of current psychiatric symptoms of incarcerated people with serious mental illness (SMI) and aggressive behavior on a penitentiary ward for crisis intervention. METHODS: One hundred sixty detainees with SMI, detained in a high-security penitentiary psychiatric facility, were screened every 2 weeks with the Brief Psychiatric Rating Scale-Extended (BPRS-E) by trained clinicians, to ensure that the data on psychiatric symptoms were up-to-date. Aggressive behavior was registered with the Staff Observation Aggression Scale-Revised. A binary logistic regression analysis was performed to examine the relationships between factor scores of the BPRS-E and aggressive behavior. RESULTS: Significant relationships between the BPRS-E factor hostility, antisocial traits, and aggressive incidents were found, but not between the positive symptoms or manic factor scores and aggressive incidents. DISCUSSION: Symptoms of SMI measured with the BPRS-E did not help to explain the occurrence of aggressive behavior. This is not in line with what is commonly found. The implication is that it can be expected that this population will display aggressive behavior but that symptoms do not help in predicting when this will occur. In addition, hostility and antisocial traits were related to aggressive behavior. For this specific population, an interactional approach might be more effective in the management of aggression than treatment of symptoms of SMI.

Domestic Violence During the Corona Pandemic: A Comparison of Pre-Pandemic and Pandemic Incidents of Domestic Violence in the Netherlands.

There is a widespread fear that the measures as a consequence of the worldwide corona pandemic have led to a significant increase in domestic violence and child abuse. The current study uses criminal files from all incidents of domestic violence that were reported to the police in a relatively large city in the Netherlands during 3.5 months before the pandemic and the first 3.5 months from the start of the nationwide shutdown, to compare the characteristics of the incident, the suspect and victim, how the case was handled and the involvement of minors. Results show that levels of domestic violence during the Covid-19-related restrictions did not increase compared to before the pandemic. During the pandemic, suspects were relatively more often men, the violence was less often reciprocal, more often took place inside the homes of suspects and victims, and was more often reported to the police by a witness than before the pandemic. Before and during the pandemic, minors were involved in respectively 34% and 43% of the incidents, mainly as witnesses of the violence between their parents. The results of the study may ease the concerns about the potential threat of domestic violence levels going through the roof during isolating measures such as during a shutdown. Limitations of the study are that official data from a single, but large, city were used and that we were not able to control for seasonal effects.

The prevalence of mental disorders and patterns of comorbidity within a large sample of mentally ill prisoners: A network analysis.

BACKGROUND: Comorbidity has profound implications in both the clinical field and research, yet little is known about the prevalence and structure of comorbid mental disorders. This article aims not only to present data on the prevalence of mental disorders and comorbidity, but also to explore relationships between comorbid mental disorders by using a network approach. METHODS: Data used in this cross-sectional study are part of a prospective cohort study within penitentiary psychiatric centers (PPCs) in the Netherlands. It includes DSM diagnoses of 5,257 unique male patients incarcerated in one of the PPC's. Prevalence rates of mental disorders and comorbidity were calculated, the network of comorbid DSM diagnoses was constructed using regression coefficients. RESULTS: Schizophrenia spectrum and substance-related disorders were most prevalent within this sample (56.7 and 43.1%, respectively), and over half of all patients were diagnosed with a comorbid disorder (56.9%). Four distinctive groups of disorders emerged from the network analysis of DSM diagnoses: substance use, impulsivity, poor social skills, and disruptive behaviors. Psychotic disorders were considered as a separate group as it was unconnected to other disorders. CONCLUSIONS: Comorbid mental disorders can be described, at least in part, as connected networks. Underlying attributes as well as direct influences of mental disorders on one another seem to be affecting the presence of comorbidity. Results could contribute to the understanding of a possible causal relation between psychopathology and criminal behavior and the development of treatment programs targeting groups of disorders.

Reduced Self-Control after 3 Months of Imprisonment; A Pilot Study.

Background: Prison can be characterized as an impoverished environment encouraging a sedentary lifestyle with limited autonomy and social interaction, which may negatively affect self-control and executive function. Here, we aim to study the effects of imprisonment on self-control and executive functions, and we report the change in neuropsychological outcome after 3 months of imprisonment. Materials and Methods: Participants were 37 male inmates in a remand prison in Amsterdam, Netherlands, who completed six tests of a computerized neuropsychological test battery (the Cambridge Automated Neuropsychological Test Battery) in the first week of arrival. Participants were retested after 3 months of imprisonment. Change in performance was tested using the Wilcoxon Signed-Rank test. Results: After 3 months of imprisonment, risk taking significantly increased (measured as an increase in the proportion of available points used for betting) and attention significantly deteriorated (measured as increased variability in reaction times on a sustained attention task), with large to medium effect sizes. In contrast, planning significantly improved (measured with a task analog to the Tower of London) with a medium effect size. Discussion: Our study suggests that 3 months of imprisonment in an impoverished environment may lead to reduced self-control, measured as increased risk taking and reduced attentional performance. This is a significant and societally relevant finding, as released prisoners may be less capable of living a lawful life than they were prior to their imprisonment, and may be more prone to impulsive risk-taking behavior. In other words, the impoverished environment may contribute to an enhanced risk of reoffending.

Ethnic variations regarding clinical profiles and symptom representation in prisoners with psychotic disorders.

BACKGROUND: Black and minority ethnic (BME) groups are known to have higher prevalences of psychotic disorders and are over-represented in western penitentiaries and forensic psychiatric institutions. Research from regular mental healthcare settings suggests that they could show different and more severe psychotic symptoms. Aims To explore ethnic variations in severity of symptomatology of BME and non-BME detainees with psychotic disorders. METHOD: In this study, 824 patients with psychotic disorders from seven different ethnic groups, imprisoned in a penitentiary psychiatric centre in the Netherlands, were compared on symptom severity and symptom representation using the BPRS-E clinical interview. Data were analysed by means of a multilevel analysis. RESULTS: BME patients with psychotic disorders are over-represented in forensic psychiatry, and symptom profiles of prisoners with psychotic disorders vary by ethnicity. Additionally, severity levels of overall psychopathology differ between ethnic groups: patients with an ethnic majority status show more severe levels of psychopathology compared with BME patients. CONCLUSIONS: There are differences in symptom severity and symptom profiles between BME patients and non-BME patients. Disregarding these differences could have an adverse effect on the outcome of the treatment. Possible explanations and clinical impact are discussed. Declaration of interest None.

Prison brain? Executive dysfunction in prisoners.

A better understanding of the functioning of the brain, particularly executive functions, of the prison population could aid in reducing crime rates through the reduction of recidivism rates. Indeed, reoffending appears to be related to executive dysfunction and it is known that executive functions are crucial for self-regulation. In the current paper, studies to executive functions in regular adult prisoners compared to non-offender controls were reviewed. Seven studies were found. Specific executive functions were found to be impaired in the general prison population, i.e., attention and set-shifting, as well as in separate subgroups of violent (i.e., set-shifting and working memory) and non-violent offenders (i.e., inhibition, working memory and problem solving). We conclude that the limited number of studies is remarkable, considering the high impact of this population on society and elaborate on the implications of these specific impairments that were found. Further empirical research is suggested, measuring executive functioning within subjects over time for a group of detainees as well as a control group.

The factor structure of the Brief Psychiatric Rating Scale (expanded version) in a sample of forensic psychiatric patients.

Severe behavioral problems, aggression, unlawful behavior, and uncooperativeness make the forensic psychiatric population both hard to treat and study. To fine-tune treatment and evaluate results, valid measurement is vital. The Brief Psychiatric Rating Scale-Extended (BPRS-E) is a widely used scale for assessing psychiatric symptoms, with a stable factor structure over various patient groups. For the first time, its usefulness for forensic psychiatric patients was studied by means of an exploratory factor analysis on 302 patients in a penitentiary psychiatric center. A five-factor solution fitted the data best and showed large overlap with previous research done in both in- and outpatient populations with schizophrenia and mixed diagnoses. Around 45% of the patients did not fully comply. Items relying most on self-report caused the most non-adherence, possibly because of difficulty with verbalizing distress. These items loaded on the factors psychosis and affect. The BPRS-E is a suitable instrument for forensic use. Future research and clinical practice should focus on alignment with forensic patients to improve measurement, understanding, and eventually therapeutic interventions.