Risk assessments and recidivism among a population-based group of Swedish offenders sentenced to life in prison.

BACKGROUND: In Sweden, the number of people serving life sentences has steadily increased. To date, few studies have examined the recidivism rate or the predictive validity of different risk assessment instruments in this group. AIMS: Our aim was to test the predictive validity among inmates serving life sentences of two different instruments used for assessing risk--the Historical, Clinical and Risk Management-20 (HCR-20), most widely used in clinical populations, and the Psychopathy Checklist-Revised (PCL-R), commonly applied in both penal and clinical settings. METHOD: Ninety-eight life-sentenced prisoners were included, 26 of whom were released during the study period. Data on risk assessments and dates for release were collected from administrative records, while recidivism data were retrieved from a national database on criminal convictions. RESULTS: Sex offenders obtained the highest scores and inmates charged with domestic violent offences obtained the lowest scores on both instruments. The released prisoners were followed for a mean period of 33 months. During this time five prisoners (19%) reoffended, four of them violently, with an average time to recidivism of 10 months. Only PCL-R Facet 4, which reflects antisocial features, was significantly associated with recidivism. CONCLUSIONS: This small, but population-based, study demonstrates that antisocial behaviour shows incremental predictive validity for reoffending among life-sentenced offenders, but other measures have little to add for this specific task. The fact that those life sentenced prisoners who reoffended did so so soon after release should prompt allocation of earlier interventions towards preventing this.

Field reliability of the Psychopathy Checklist-Revised among life sentenced prisoners in Sweden.

Although typically described as reliable and valid, the Psychopathy Checklist-Revised (PCL-R) has come under some criticism by researchers in the last half-decade due to evidence of poor interrater reliability and adversarial allegiance being reported in applied settings in North America. This study examines the field reliability of the PCL-R using a naturalistic test-retest design among a sample of Swedish life sentenced prisoners (N = 27) who had repeatedly been assessed as part of their application to receive a reduced prison term. The prisoners, who were assessed by a team of forensic evaluators retained by an independent government authority, had spent on average 14 years in prison with a mean time from Assessment 1 to Assessment 2 of 2.33 years. The overall reliability of the PCL-R (ICC(A1)) was .70 for the total score and .62 and .76 for Factor 1 and 2 scores, respectively. Facet 1-3 scores ranged from .54 to .60, whereas Facet 4 was much higher (.90). Reliability of individual items was quite variable, ranging from .23 to .80. In terms of potential causes of unreliability, both high and low PCL-R scores at the initial assessment tended to regress toward the mean at the time of the second evaluation. Our results are in line with previous research demonstrating concerns regarding the reliability of the PCL-R within judicial settings, even among independent evaluation teams not retained by a particular side in a case. Collectively, these findings question whether the interpersonal (Facet 1) and affective (Facet 2) features tapped by the PCL-R are reliable enough to justify their use in legal proceedings.

Violent behavior, impulsive decision-making, and anterograde amnesia while intoxicated with flunitrazepam and alcohol or other drugs: a case study in forensic psychiatric patients.

It is known that many male juvenile delinquents commit violent crimes while intoxicated with flunitrazepam (FZ), often in combination with alcohol or other drugs. We have also noted the combined abuse of FZ with, for example, alcohol in male forensic psychiatric patients. Our objective was to study violent behavior, impulsive decision-making, and amnesia in male forensic psychiatric patients who were intoxicated predominantly with FZ, to increase knowledge of the abuse of FZ in vulnerable subjects. We studied five forensic psychiatric patients, all of whom were assessed in 1998. All of the subjects reported earlier reactions to FZ, including hostility and anterograde amnesia. At the time of their crimes they were all intoxicated with FZ, often in combination with alcohol or other drugs, such as amphetamine or cannabis. In contrast to their behavior based on their ordinary psychological characteristics, their crimes were extremely violent, and the subjects lacked both the ability to think clearly and to have empathy with their victims. Our observations support the view that FZ abuse can lead to serious violent behavior in subjects characterized by vulnerable personality traits, and that this effect is confounded by the concurrent use of alcohol or other drugs. It is evident that FZ causes anterograde amnesia. Previous research and the results presented herein allow us to draw the following conclusion: on the basis of the neuropsychopharmacologic properties of FZ, legal decisions, such as declaring FZ an illegal drug, are needed in countries where it is now legal.