Exploratory rasch analysis of a static-99R clinical cohort assessment.

Modern test theory supplements the more prevalent classic methods for assessing test properties. However, such an assessment of the commonly used sexual recidivism risk assessment instrument, Static-99R, has yet to be attempted. This study evaluated the psychometric properties of said instrument using Rasch analysis. The clinical cohort assessed consisted of individuals with mental disorders convicted of a sexual offense (N = 146). Results showed that the original ten-item Static­99R did not meet the Rasch model requirements, and revisions of the instrument with seven and nine items each only marginally improved performance. More reliable results could likely have been obtained with a larger, non-clinical sample and a more randomized distribution of missing data. Despite the consistently poor performance of item 3 ("Index non-sexual violence") in all three analyses, reliability was slightly improved by dichotomizing the only two polytomous items in the Static-99R; items 1 ("Age at release from index offense") and 5 ("Prior sexual offenses"). These results may be of interest considering the significant change of splitting the formerly dichotomous item 1 into four different response categories in the revision of Static-99 to Static-99R.

Experts' decision-making processes in Swedish forensic psychiatric investigations: A case vignette study.

It has previously been demonstrated that decisions made by forensic experts can suffer from issues with both bias and poor reliability. The outcome of Swedish forensic psychiatric investigations can have a major impact on the courts' choice of sanction for a mentally disordered offender. These investigations are performed by multi-professional teams of experts, where each expert is obliged to state their opinion on whether the client has a severe mental disorder (SMD) or not. In the present study, a case vignette design was used to simulate the decision-making process of forensic psychiatric investigations. Of the 73 Swedish experts working with forensic psychiatric investigations, a total of 27 (37%) participated in the study. The results showed that the Swedish experts formulated multiple diagnostic hypotheses about cases throughout the process and revised these hypotheses when presented with new information. There was substantial variation between the experts in which hypotheses were seen as most relevant. While the experts grew more certain of their opinions on SMD during the simulated investigation, there was considerable variation in their opinions both throughout and at the end of the process. Although low statistical power and the sample not being randomized limit generalizations, the results indicate no idiosyncratic patterns in the decision-making processes of Swedish experts or signs of confirmation bias. If used properly, the variation in both process and outcome could be used to safeguard and possibly increase the reliability and validity of the final decision of Swedish forensic psychiatric investigations.

Prevalence and heritability of alcohol use disorders in 18-year old Swedish twins.

Background: Heritability of alcohol use disorders (AUDs) varies widely, with reported estimates of 30-78% in twin studies. This variation might be due to methodological differences (e.g., using different thresholds for AUDs, age differences between samples). Aim: To investigate the heritability of AUDs in a nation-wide sample of male and female twins in late adolescence (18 years). Participants: The study is based on data from 8,330 18-year-old Swedish monozygotic (MZ) and dizygotic (DZ) twins from the Child and Adolescent Twin Study (Sweden). Method: Univariate sex-limitation twin analyses were performed using (a) total AUDIT score, (b) different AUDIT cut-offs (AUDIT-10: potentially harmful alcohol use and most likely alcohol dependent ; AUDIT-C: potential hazardous alcohol consumption/active alcohol use disorders), and (c) a risk-group classification for alcohol dependence based on AUDIT total score. Results: Prevalence of potential hazardous alcohol consumption/active alcohol use was 57.1%, and for potentially harmful alcohol use prevalence was 26.5%. Prevalence was higher among females (59.0% and 31.1% respectively) than males (54.4% and 20.0% respectively). Overall, the results of the univariate model fitting indicated that there were qualitative sex differences in the genetic and environmental influences on AUDs, with generally moderate heritability estimates ranging between 0.37 and 0.50. Discussion: At odds with previous research, a harmful/hazardous drinking pattern was more common in this age group among females than a low-risk drinking pattern (where males were overrepresented). Heritability estimates were moderate throughout all measures and cut-offs, with equally high contributions from shared and non-shared environment. Sex-limitation models revealed qualitative sex differences for AUDs, suggesting that different genetic and/or environmental factors influence variation in AUDs in males and females.

Plasma neurofilament light chain protein is not increased in forensic psychiatric populations: a pilot study.

Introduction: Neurofilament light chain protein (NfL) is a fluid biomarker of neural injury measurable in cerebrospinal fluid and blood. Patients with different neurodegenerative disorders and mild traumatic brain injury display elevated levels of NfL. However, so far, elevated levels of NfL have not been demonstrated in persons with psychiatric disorders. To our knowledge, the occurrence of NfL in the blood has not previously been studied in persons undergoing forensic psychiatric assessment or persons treated in forensic mental health services. Supposedly, these persons suffer from experiences and conditions with a higher risk of neural injury than other psychiatric patients. Methods: In this pilot study, we investigated plasma levels of NfL in 20 persons undergoing forensic psychiatric assessment and 20 patients at a forensic psychiatric hospital. NfL values were compared with control groups of healthy individuals matched for age and sex. Results: The prevalence of increased NfL in both forensic groups was low and did not differ compared with the controls. However, some persons undergoing forensic psychiatric assessment showed slightly elevated values. Discussion: The slightly elevated values were observed in the group investigated closer in time to the index crime, when elevated NfL levels could be expected to be more prevalent due to acute conditions from the time of the offense. This gives reason to look further into this group.

Lethal and severe violence: Characterizing Swedish female offenders with and without a severe mental disorder.

Aim: In studies on lethal and severe violence, male offenders have historically been in focus while female offenders, in comparison, have often been excluded. In this study, we aimed to characterize female violent offenders and compared those with and without a severe mental disorder (SMD). Method: All females charged with lethal or attempted lethal violence, who had undergone forensic psychiatric investigations (FPI) in Sweden between 2000 and 2014, constituting the two groups SMD (n = 84) and no SMD (n = 91), were included. Information from their FPI reports and court verdicts was collected regarding background and demographics, mental health, substance use, and crime characteristics. Results: Overall, both groups were often unemployed, previously victimized within close relations, had psychiatric health issues, and more than half of them had previously attempted suicide. Specifically, the SMD group more often had psychotic disorders, had attempted homicide-suicide (at the time of the crime), and had children or friends/acquaintances as victims. The no-SMD group more often manifested patterns of anxiety, personality disorders, and substance use disorders compared to the SMD group. The no-SMD group also differed from the SMD group by more often having a previous criminal record, being charged with lethal index violence, having male adult intimate partners/ex-intimate partners as victims who had abused the offender, and both offender and victim had more often been under the influence of a substance. Conclusion: Female offenders of lethal and severe violence had a high prevalence of previous violent victimization which should be considered in forensic assessment and treatment regardless of the offender's SMD status. However, more focus on substance use disorders and intimate partner relations appears relevant for females without an SMD. Contrary to that, early interventions regarding psychotic processes are probably a helpful preventive measure for females with an SMD. In sum, the heterogeneity of female offenders of lethal and severe violence emphasizes the necessity of developing nuanced interventions to meet their rehabilitative needs as well as the requirements of community protection.

Criminal recidivism of patients in Swedish forensic psychiatry: A register-based comparison study.

BACKGROUND: The aim of this study was to evaluate criminal outcomes of mentally disordered offenders in compulsory forensic psychiatric care during the year 2010 versus 2018. More specifically, we sought to identify the occurrence of new criminal sentences during ongoing treatment and possible factors associated with recidivistic criminality. Another aim was to map previous criminality, types of index crime, and whether there were any changes within this decade. METHODS: Crime-, clinical, and treatment-related variables were collected from the Swedish National Forensic Psychiatric Register for all unique inpatients registered from January 1-December 31 in 2010 (N = 717) and 2018 (N = 757). The mean, frequency, percentage, and standard deviation were calculated per variable and stratified by study year and gender. Between-group comparisons were made using t-tests and Chi-square tests. Binary logistic regression was performed to determine whether variables expected to be associated with recidivism showed any relation to criminal recidivism for each study cohort. RESULTS: Most patients were male and approximately one-quarter and one-half of the men, respectively, had a previous sentence for non-violent and violent crimes. The 2018 cohort showed significantly lower rates of sentences to forensic psychiatry with special court supervision although the numbers were low in both cohorts and for both men and women. Previous violent conviction was associated with criminal recidivism during treatment in 2010, while this was joined by index crime under the influence of alcohol/illicit drugs for the 2018 cohort. CONCLUSIONS: Overall, these results showed more similarities between the 2010 and 2018 cohorts then dissimilarities, while on the other hand some quite substantial differences were described between males versus females. The results of this study indicate that it may be possible to tailor forensic psychiatric treatment to gender as a proxy for other variables related to increased criminal recidivism in offenders sentenced to forensic psychiatric care.

Criminal recidivism in offenders with and without intellectual disability sentenced to forensic psychiatric care in Sweden-A 17-year follow-up study.

Background: Offenders with intellectual disability (ID) constitute a distinct subgroup of offenders with mental disorders. Regarding criminal recidivism, it is unclear whether or not offenders with ID in forensic psychiatric settings differ from offenders without ID. Factors associated with criminal recidivism among offenders with ID have been scarcely investigated. Aim: To investigate the association between ID and criminal recidivism among offenders sentenced to forensic psychiatric care and to explore the impact of clinical, sociodemographic and offense variables. Materials and methods: We conducted a retrospective cohort study based on Swedish nationwide registers. A total of 3,365 individuals being sentenced to forensic psychiatric care in Sweden in 1997-2013 were followed from the forensic psychiatric assessment until first reconviction, death, emigration, or 31 December 2013, whichever occurred first. Cox regression models compared rates of recidivism in individuals with and without ID. Impact of clinical, sociodemographic, and offense variables on risk of criminal recidivism was presented as hazard ratios (HRs) with 95% confidence intervals (CIs). Results: Out of 3,365 offenders sentenced to forensic psychiatric care, 259 (7.7%) were diagnosed with ID. During follow-up (0-17 years, median 6 years), one third (n = 1,099) of the study population relapsed into criminality, giving a recidivism rate of 50.5 per 1,000 person-years. We observed an association between ID and a decreased risk of recidivism (HR 0.8, 95% CI 0.6-1.0, p = 0.063), although this reached statistical significance only for the subgroup of male offenders (HR 0.8, 95% CI 0.6-1.0, p = 0.040) and not females (HR 1.0, 95% CI 0.6-1.8). ID offenders with concurrent ADHD tended to have a higher rate of recidivism (73.9 per 1,000 person-years, HR 1.2, 95% CI 0.6-2.4) than ID offenders without ADHD (42.5 per 1,000 person-years, HR 0.8, 95% CI 0.6-1.1). Amongst ID offenders, concurrent autism spectrum disorder, young age or male sex were not associated with recidivism, while previous criminal convictions were strongly associated with recidivism. Conclusion: A diagnosis of ID was associated with a lower risk of criminal recidivism among male offenders sentenced to forensic psychiatric care. The association between ADHD and recidivism among ID offenders highlights eligible focus areas in the management of offenders with ID.

Decision-Making Within Forensic Psychiatric Investigations: The Use of Various Information Sources by Different Expert Groups to Reach Conclusions on Legal Insanity.

Background: Which type of information experts use to make decisions regarding legal insanity within forensic psychiatric investigations (FPI) is relatively unknown, both in general and when considering variations due to case context. It is important to explore this area to be able to counteract the effects of various kinds of cognitive bias. Method: The aim was to explore whether FPI expert groups differed regarding case-specific as well as general use of information types required to make decisions on severe mental disorder (SMD). Three FPI case vignettes were presented to three professional groups involved in FPIs in Sweden (n = 41): forensic psychiatrists (n = 15), psychologists (n = 15), and social workers (n = 11). The participants reported which types of information they required to reach conclusions regarding SMD in each case. They also reported which types of information they had used within general FPI praxis during the previous year and the information types' perceived usefulness. Results: The expert groups differed somewhat regarding what type of information they required for the cases (e.g., results from cognitive testing), but some information was required in all cases (e.g., client's self-report). Regarding the preliminary assessment of SMD in the three cases, minor differences were found. Within the general FPI praxis, experts reported using several information types, while the general perceived usefulness of these sources varied. Discussion: The professional groups relied partly on a "core" of information sources, but some case-specific adaptations were found. The professional groups' inclination to suspect SMD also varied somewhat. This indicates a need to explore the potential consequences of these similarities and differences.

Prolonged NoGo P3 latency as a possible neurobehavioral correlate of aggressive and antisocial behaviors: A Go/NoGo ERP study.

Aggressive and antisocial behaviors are detrimental to society and constitute major challenges in forensic mental health settings, yet the associated neural circuitry remains poorly understood. Here, we investigated differences in aggressive and antisocial behaviors between healthy controls (n = 20) and violent mentally disordered offenders (MDOs; n = 26), and examined associations between aggressive and antisocial behaviors, behavioral inhibitory control, and neurophysiological activity across the whole sample (n = 46). Event-related potentials were obtained using EEG while participants completed a Go/NoGo response inhibition task, and aggressive and antisocial behaviors were assessed with the Life History of Aggression (LHA) instrument. Using a robust Bayesian linear regression approach, we found that MDOs scored substantially higher than healthy controls on LHA Aggression and Antisocial subscales. Using the whole sample and after adjusting for age, we found that scores on the LHA Aggression and Antisocial subscales were robustly associated with longer NoGo P3 latency, and less robustly with longer NoGo N2 latency. Post-hoc analyzes suggested that healthy controls and MDOs exhibited similar associations. With several limitations in mind, we suggest that prolonged NoGo P3 latency, reflecting decreased neural efficiency during the later stages of conflict monitoring or outcome evaluation, is a potential neurobehavioral correlate of aggressive and antisocial behaviors.

The decision-making process in Swedish forensic psychiatric investigations.

Forensic psychiatric investigations in Sweden can have a major impact on the choice of sentence in criminal cases. Previous research shows that the decisions in several forensic fields, including forensic psychiatry, can be affected in a negative way by factors not relevant to the case. In the present study, the decision-making process of forensic psychiatric investigations was explored by using semi-structured interviews with experts (n = 38) and analyzing these interviews thematically. The results showed that the decision-making process is both complex and iterative, where the experts use and shape a substantial amount of information to reach their decisions. The experts work in teams, which add both benefits and risks to the process, and feel that particularly time constraints may reduce the quality of their decisions. In summary, the decision-making process of Swedish forensic psychiatric investigations creates a potential for high validity, but also contains risks for bias effects that could warrant further mitigation.

A register-based comparison study of Swedish patients in forensic psychiatric care 2010 and 2018.

PURPOSE: This study compared the characteristics of a population of Swedish patients in forensic psychiatric care in the year 2010 and 2018, with the goal of identifying similarities and differences in sociodemographic and clinical outcomes during the study period. FINDINGS: Significant changes in patient characteristics and treatment aspects were found, although similarities between the years were more common. Schizophrenia, schizotypal and delusional disorders were the most predominant primary diagnoses characterizing forensic psychiatric patients. From 2010 to 2018 there was also a development in care conditions supporting a shift from inpatient to outpatient care and from first-generation antipsychotic/neuroleptic to second-generation antipsychotics/atypical antipsychotics. More liberty restrictive such as physical restraints and forcible medication diminished while less restrictive coercive measures increased. There was also a decrease in the length of stay in forensic psychiatric care among those treated 2018 compared to those treated 2010, something that emerged as particularly discernible among male patients. CONCLUSION: In conclusion, the results from this study illustrate the similarities among a Swedish forensic psychiatric population between the years of 2010 and 2018, while also reflecting some changes in patient characteristics and clinical practice during the study period.

Structural Brain Correlates of the Externalizing Spectrum in Young Adults.

The externalizing spectrum, including traits and behaviors such as aggression, reduced inhibitiory control and substance abuse, is associated with altered prefrontal brain morphology. However, the degree to which different manifestations of the externalizing spectrum are associated with distinct or overlapping variations in individual brain morphology is unclear. Here, we therefore used structural magnetic resonance imaging, self-report assessment, and a response inhibition task in a sample of 59 young adults to examine how cortical thickness in the anterior cingulate cortex (ACC), orbitofrontal cortex (OFC), and dorsolateral prefrontal cortex (DLPFC) relate to four different manifestations of the externalizing spectrum: disinhibition, callous aggression, substance abuse, and behavioral inhibitory control. Using Bayesian linear regression models controlling for age, gender, and years of education, we found that the different manifestations of the externalizing spectrum were associated with both distinct and overlapping morphology variations. Specifically, both callous aggression and inhibitory control was associated with increased cortical thickness of the OFC, a region involved in reward processing, decision-making, and regulation of anxiety and fear. Both disinhibition and substance abuse were associated with DLPFC thickness, although with opposite association patterns, possibly reflecting processes related to inhibitory control, working memory and attention. Moreover, disinhibition, but not callous aggression or substance abuse, was associated with behavioral inhibitory control. Our results provide further support for the link between externalizing behaviors and prefrontal brain morphology, while identifying distinct prefrontal areas associated with different clinically relevant manifestations. These findings may help guide further research aimed at developing novel treatment and intervention strategies for externalizing behaviors and disorders.

A Static-99R Validation Study on Individuals With Mental Disorders: 5 to 20 Years of Fixed Follow-Up After Sexual Offenses.

'The Static-99R is one of the most commonly used risk assessment instruments for individuals convicted of sexual offenses. It has been validated for use on many populations, but few studies specifically target and describe individuals with mental disorders. Additionally, research on the discriminative properties (how well the instrument separates recidivists from non-recidivists) of the instrument over longer follow-up periods is scarce. This article evaluated the validity of the Static-99R using a cohort of individuals with mental disorders convicted of sexual offenses in Sweden (N = 146) with fixed 5-year (n = 100), 10-year (n = 91), 15-year (n = 79), and 20-year (n = 36) follow-up periods. A Static-99R cut score of 6 demonstrated the highest Youden index, maximizing sensitivity (72.7%) and specificity (74.2%), with 25.8% of recidivists correctly assumed to reoffend sexually and 95.7% of non-recidivists correctly assumed not to. The Static-99R instrument demonstrated adequate discrimination (AUC = 0.79, CI 95% = 0.70-0.87, and OR = 1.45, CI 95% = 1.14-1.84, p < 0.001, 5-year fixed follow-up), with only marginal differences for 10-, 15-, and 20-year fixed follow-up (AUC = 0.73, 0.74, and 0.74 and OR = 1.31, 1.36, and 1.40, respectively). Calibration (quantifying risk and correspondence with the instrument's norms) was acceptable (Brier = 0.088, P/E = 0.70, E/O = 1.43), with the routine sample norms displaying a decisively better fit to the study cohort compared to the high-risk/high-need sample norms. The results affirm the recommendation that, when in doubt and where there is no recent local norm group large enough available, the Static-99R routine sample found in the evaluators' workbook should be used.

The use of physical exercise in forensic psychiatric care in Sweden: a nationwide survey.

BACKGROUND: Exercise protects against somatic comorbidities and positively affects cognitive function and psychiatric symptoms in patients with severe mental illness. In forensic psychiatry, exercise is a novel concept. Staff at inpatient care facilities may be important resources for successful intervention. Little is known about staff's knowledge, attitudes and behaviors regarding exercise in forensic psychiatric care. AIMS: To translate, culturally adapt and test the feasibility of the Exercise in Mental Health Questionnaire-Health Professionals Version (EMIQ-HP) in the Swedish context, and to use this EMIQ-HP-Swedish version to describe staff's knowledge, attitudes and behaviors regarding exercise. METHOD: The EMIQ-HP was translated, culturally adapted, pilot-tested and thereafter used in a cross-sectional nationwide survey. RESULTS: Ten of 25 clinics and 239 health professionals (50.1%) participated. Two parts of the EMIQ-HP-Swedish version showed problems. Most participants considered exercise to be a low-risk treatment (92.4%) that is beneficial (99.2%). Training in exercise prescription was reported by 16.3%. Half of participants (52.7%) prescribed exercise and 50.0% of those undertook formal assessments prior to prescribing. CONCLUSIONS: Creation of the EMIQ-HP-Swedish version was successful, despite some clarity problems. Exercise appears to be prescribed informally by non-experts in Swedish forensic psychiatric care and does not address treatment goals.

Trait Disinhibition and NoGo Event-Related Potentials in Violent Mentally Disordered Offenders and Healthy Controls.

Trait disinhibition may function as a dispositional liability toward maladaptive behaviors relevant in the treatment of mentally disordered offenders (MDOs). Reduced amplitude and prolonged latency of the NoGo N2 and P3 event-related potentials have emerged as promising candidates for transdiagnostic, biobehavioral markers of trait disinhibition, yet no study has specifically investigated these two components in violent, inpatient MDOs. Here, we examined self-reported trait disinhibition, experimentally assessed response inhibition, and NoGo N2 and P3 amplitude and latency in male, violent MDOs (N = 27) and healthy controls (N = 20). MDOs had a higher degree of trait disinhibition, reduced NoGo P3 amplitude, and delayed NoGo P3 latency compared to controls. The reduced NoGo P3 amplitude and delayed NoGo P3 latency in MDOs may stem from deficits during monitoring or evaluation of behavior. NoGo P3 latency was associated with increased trait disinhibition in the whole sample, suggesting that trait disinhibition may be associated with reduced neural efficiency during later stages of outcome monitoring or evaluation. Findings for NoGo N2 amplitude and latency were small and non-robust. With several limitations in mind, this is the first study to demonstrate attenuated NoGo P3 amplitude and delayed NoGo P3 latency in violent, inpatient MDOs compared to healthy controls.

Exploring Traumatic Brain Injuries and Aggressive Antisocial Behaviors in Young Male Violent Offenders.

Background: Traumatic brain injury (TBI) is a major cause of disabilities and mortality worldwide, with higher prevalence in offender populations than in the general population. Previous research has strongly advocated increased awareness of TBI in offender populations. The aim of this study was to explore the prevalence and characteristics of TBI, and to investigate associations and interactions between TBI, aggressive antisocial behaviors, general intellectual functioning, and substance use disorders (SUD) in a well-characterized group of young violent offenders. Methods: The study investigated a cohort (n = 269) of 18 to 25-year-old male violent offenders in Sweden. Data on TBI (files + self-report), aggressive antisocial behaviors (Life History of Aggression), SUD (clinical interviews), and general intellectual functioning (General Ability Index, Wechsler Adult Intelligence Scales Third Edition) were collected between 2010 and 2012. Parametric (Student's t-test) and non-parametric (Mann-Whitney U-test, Spearman's rho, χ2, Kruskal Wallis test) inferential statistics were applied and effect sizes reported. Results: TBI, both with and without loss of consciousness, was common, with 77.5% of the offenders reporting having suffered at least one TBI during their lifetime. TBI was associated with an increased occurrence of aggressive antisocial behaviors and SUD, and offenders with both TBI and SUD evidenced the largest amount of aggressive antisocial behaviors. No clinically meaningful associations were found between TBI and general intelligence. Effect sizes were in the small to medium range. Conclusions: Our study confirms an increased prevalence of TBI among young violent offenders compared to the general population, as well as associations between TBI, aggressive antisocial behaviors, and SUD. However, it provides no information on the severity of the TBI, nor on the causality of the demonstrated associations. Nevertheless, TBI, and possible related deficits, need to be considered in the assessment and treatment of young violent offenders.

Clinical Characteristics and Pharmacological Treatment of Individuals With and Without Intellectual Disability in Pre-trial Assessment-A Population-Based Study.

Background: The current lack of knowledge about intellectual disability (ID) in forensic psychiatric contexts can compromise the legal certainty of these individuals during the medico-legal process. To address ambiguous results in previous literature, the aim of the current study was to estimate the prevalence of ID in a pre-trial forensic psychiatric settings. Moreover, as little is known about the characteristics of offenders with ID, we conducted a clinical characterization of individuals with and without ID being subject to forensic psychiatric assessment. Methods: Using data from several Swedish national registers, we conducted a population-based retrospective observational study on 8,442 individuals being subject to pre-trial forensic psychiatric assessments in Sweden in 1997-2013. We performed univariate analyses to compare the characteristics of individuals with (n = 537) and without ID (n = 7,905). Results: The prevalence of ID was 6.4% in the Swedish pre-trial forensic psychiatric context during the observational period. Compared with individuals without ID, individuals with ID were younger at the time of assessment, had a lower educational level, and had less frequently started families. ID was associated with lower frequency of diagnosed psychotic and bipolar disorders. However, a similar prescription rate of antipsychotics, and a comparable rate of previous inpatient care was observed among individuals with and without ID. Individuals with ID had more often been prescribed anti-libidinal treatments often used for treating sexual disorders, although did not present a higher prevalence of sexual disorder. Conclusions: The prevalence of ID among pre-trial individuals being subject to forensic psychiatric assessment was more than twice as high as assumed in the general population. Our results suggest that individuals with ID received pharmacotherapy without clear indication. Remaining challenges in the clinical management of individuals with ID were indicated by the discrepancy between the occurrence of psychiatric diagnoses, pharmacological treatment patterns, and rates of inpatient care.

Corrigendum: Examining Associations Between Psychopathic Traits and Executive Functions in Incarcerated Violent Offenders.

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A 24-Year Follow-up Study on Recidivism in Male Mentally Disordered Sexual Offenders With and Without Psychotic Disorders.

There is a lack of knowledge on mentally disordered sex offenders (MDSOs) targeting adult victims, especially regarding recidivism patterns and the specific subgroup with psychiatric disorders. This paper presents index offense data, clinical data, and recidivism patterns over up to 24 years in a cohort of 146 MDSOs, with and without psychotic disorders, sentenced in Sweden between 1993 and 1997. At the time of the offense, all offenders were affected by clinical, developmental, and criminal history factors. MDSOs with psychotic disorders only marginally differed from those without, the former being less likely to have been institutionalized during childhood, intoxicated during the index offense, or diagnosed with a personality disorder, substance use disorder, or paraphilic disorder. In the cohort, 3.4% of the MDSOs were reconvicted for a new sex offense over 2 years, 9.6% over 5 years, 13.0% over 10 years, and 17.1% over the entire follow-up period of 24 years. In MDSOs with psychotic disorders, no subjects were reconvicted during the first 2 years, while 2.6% were reconvicted over 5 years, 5.3% over 10 years, and 7.9% over 24 years. Recidivism rates for violent and general reoffenses were 39.0% and 37.7%, respectively, for the cohort of MDSOs, and subjects with psychotic disorders reoffended significantly later in general offenses. In conclusion, MDSOs with psychotic disorders showed the same recidivism pattern as MDSOs without psychotic disorders. Furthermore, recidivism research may preferably focus on follow-up periods of 5-10 years since most offenders appear to recidivate within this timeframe.

Physical performance and physical activity of patients under compulsory forensic psychiatric inpatient care.

Research stresses the importance of physical activity in general psychiatric care. There is very little research made in the area of forensic psychiatric care. The aim of this exploratory, cross-sectional study was to assess various physical, psychological, and health variables of patients under compulsory forensic psychiatric inpatient care, and to examine correlations among these variables. Maximal oxygen uptake (VO2max), walking ability, running speed, and explosive leg strength were examined in 28 patients. Patients answered questionnaires about physical activity, aggression, stress, character maturity, and health-related quality of life (HRQL). The patients had a mean age of 33.6 years, a mean VO2max of 25.3 (8.4) mL 02/min/kg and a mean physical activity level of 268.0 (272.4) min/week. Results from the 6-min walk test were 612.5 (102.8) m. Nine patients had physical activity levels below the international recommendations of 150 min/week. Levels of aggression and stress were high and HRQL was low. The results indicate that patients in forensic psychiatric care are in a very poor physical state, which warrants physiotherapeutic interventions, adapted to the unique demands of forensic psychiatric care.