Relapse in violent crime in relation to cerebrospinal fluid monoamine metabolites (5-HIAA, HVA and HMPG) in male forensic psychiatric patients convicted of murder: a 16-year follow-up.

OBJECTIVE: Our purpose was to investigate if low levels of cerebrospinal fluid (CSF) monoamine metabolites of 5-HIAA, HVA and HMPG predict relapse in violent crimes. METHOD: Relapse in crime and level of CSF monoamine metabolites (5-HIAA, HVA and HMPG) was studied in a group of 29 murderers. The follow-up was 16 years. RESULTS: Fourteen of the 29 murderers were convicted of crime; nine of them committed violent crimes; one was convicted of a new murder. The differences in mean CSF monoamine metabolites were lower in subjects who relapsed into any type of crime, but only the difference in mean CSF HVA was statistically significant. CONCLUSION: The risk to commit new murder is very small in males who earlier have been convicted of murder. Low levels of CSF HVA is associated with an increased risk for relapse in any type of crime.

[Using projective tests in forensic psychiatry may lead to wrong conclusions. Only empirically tested tests should be used]. / Projektiva test inom rättspsykiatrin medför risker för rättssäkerheten. Endast metoder med god empirisk förankring bör användas.

The use of projective and psychometric psychological tests at the Department of Forensic Psychiatry in Stockholm (Huddinge), Sweden, was studied for a population of 60 men, including many patients with neuropsychological disabilities and multiple psychiatric disorders. The results showed that the use of projective tests like Rorschach, Object Relations Test, and House-Tree-Person was more frequent than the use of objective psychometric tests. Neuropsychological test batteries like the Halstead-Reitan Neuropsychological Test Battery or Luria-Nebraska Neuropsychological Battery were not used. The majority of patients were, however, assessed by intelligence scales like the WAIS-R. The questionable reliability and validity of the projective tests, and the risk of subjective interpretations, raise a problem when used in a forensic setting, since the courts' decisions about a sentence to prison or psychiatric care is based on the forensic psychiatric assessment. The use of objective psychometric neuropsychological tests and personality tests is recommended.

Suicide attempts and impulse control disorder are related to low cerebrospinal fluid 5-HIAA in mentally disordered violent offenders.

OBJECTIVE: The aim of this study was to investigate the relationship between low cerebrospinal fluid 5-hydroxyindoleacetic acid (CSF 5-HIAA) and aggressive acts in mentally disordered violent offenders. METHOD: CSF concentrations of 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid and 4-hydroxy-3-methoxyphenyl glycol were measured in 35 drug-free men convicted of homicide and currently undergoing forensic psychiatric investigation in a high security hospital. RESULTS: The mean metabolite concentrations in the homicide offenders did not differ from those of age- and body-height matched male control subjects. One-third of the murderers had made one or several suicide attempts, and their mean concentration of spinal fluid 5-HIAA was significantly lower than that of the remaining murderers. Subjects with impulse control disorder also had lower mean CSF 5-HIAA. A consistent pattern of higher CSF 5-HIAA in subjects with more self-reported anxiety traits was observed. CONCLUSION: The association between serotonin and suicidal behaviour holds for yet another subject group. Determining CSF 5-HIAA might be worth while in the routine assessment of psychiatrically ill homicide offenders.

Flunitrazepam (Rohypnol) abuse in combination with alcohol causes premeditated, grievous violence in male juvenile offenders.

This study focuses on 19 juvenile offenders who were frequently intoxicated by flunitrazepam (FZ), almost exclusively under the brand name Rohypnol. Street names for Rohypnol tablets are Rophies, Ropies, Roofies, Ropes, Roches, Rochas, Rochas Dos, Rophs, Ropers, Ribs, R-25, Roach-2s, Trip and Fall, Remember All, Mind Erasers, Forget Pills, and the Date Rape Drug. An overdose of FZ gives an increased feeling of power and self-esteem, reduces fear and insecurity, and provides the belief that everything is possible. FZ is also associated with loss of episodic memory and with impulsive violence, particularly when combined with alcohol. The subjects were taken from a subpopulation of 47 male juvenile offenders from Swedish national correctional institutions. Background information for subjects was obtained by in-depth interviewing and personality inventories including the Zuckerman Sensation-Seeking Scales, the Eysenck Personality Questionnaire, and the Karolinska Scales of Personality. Data concerning previous criminal offenses was obtained from the Swedish National Police Board. Almost all of the FZ abusers had been previously sentenced for serious violent offenses. Our data suggest that FZ abused by psychiatrically vulnerable subjects (i.e., with high scores on boredom susceptibility and verbal aggression) poses a serious hazard both to the abusers as well as the community. Our results support the finding that FZ should be classified as a Schedule I drug (i.e., a drug similar to heavy narcotics).

[Rohypnol should be classified as a narcotic]. / Rohypnol bör klassas som tung narkotika.

Flunitrazepam, widely known by its trade names (e.g. Rohypnol), may cause severe violence, especially in combination with alcohol. Flunitrazepam abusers become cold-blooded, ruthless and violent, and do not remember their violence. Reputedly it is supplied to professional hit-men and enforcers by their bosses to promote ruthless efficacy. One case report describes how a young man, intoxicated with flunitrazepam and involved in causing serious knife and gunshot wounds and taking hostages, felt so invincible that he openly challenged the police, threatening them with an assault rifle, but was himself shot. Flunitrazepam may exert pharmacological effects on GABA-ergic systems, thus lowering serotonin levels. The impulsive execution of violent crimes and suicide attempts in which a violent method (hanging, shooting, self-stabbing) has been used are associated with the presence of low serotonin levels. It is therefore recommended that flunitrazepam should be classified as a controlled substance in Sweden as it is elsewhere.

Criminal multilation of the human body in Sweden--a thirty-year medico-legal and forensic psychiatric study.

During the 30-year period 1961-1990, a total of 22 deaths with criminal multilation/dismemberment of the human body were registered in Sweden. The multilations occurred in time clusters, mostly during the summer and winter periods, and increased during the three decades, with incidence rates of 0.05, 0.1, and 0.125 per million inhabitants and year, respectively. Multilation was noted 6.6 times more often in large urban areas than in the rest of Sweden. Defensive mutilation, in order to get rid of the corpse or make its identity more difficult, was noted in ten instances, aggressive mutilation following outrageous overkilling in four, offensive mutilation (lust murder) in seven, and necromanic multilation in one instance. In the last-mentioned case the cause of death was natural, while all deaths in the first three groups were homicidal, or homicide was strongly suspected. All perpetrators were males, in six instances assisted by other persons. In more than half of the cases the perpetrator's occupation was associated with application of anatomical knowledge, e.g., butcher, physician, veterinary assistant, or hunter. The perpetrators of the defensive and aggressive mutilations were mostly disorganized, i.e., alcoholics or drug users with previous psychiatric contacts and criminal histories, while the lust murderers were mostly organized, with a history of violent crimes (including the "serial killing" type), drug abuse and mental disorders with anxiety and schizophrenia, in that order to a diminishing degree. There were differences in mode of mutilation, depending on whether the mutilation was carried out by a layman, a butcher, or a physician. In only one case was the perpetrator convicted for the mutilation act itself; in the remaining instances the manslaughter, as a more serious crime, assimilated the mutilation. When the mutilation made it impossible to establish the cause of death, the perpetrators, despite strong circumstantial evidence indicating murder, were acquitted.

Violent mass shootings in Sweden from 1960 to 1995: profiles, patterns, and motives.

During the past few decades, violent mass shooting in Sweden has increased rapidly. In the 36 years between 1960 and 1995, fourteen such occasions were recorded, during which 32 people were killed and 57 were wounded. The 14 offenders were men between the ages of 17 and 61 years. In the 20 years from 1960 to 1979, five shootings were committed by five offenders, leaving 10 dead and 13 wounded; in the 16 years between 1980 and 1995, there were nine different shootings committed by nine offenders, with 22 dead and 44 wounded. Seven of the shootings were classified as mass shootings, six as spree shootings, and one as a serial shooting. In all but four of these cases, the firearms used were illegal weapons. The four legal firearms belonged to an unemployed young laborer, an officer, a former United Nations (U.N.) soldier, and a member of the Swedish military volunteer corps. Of those killed, 68.8% were strangers to the offender; among the wounded, the corresponding figure was 89.5%. Profiles of the offenders and of the victims were studied. The psychiatric diagnoses among the offenders and the measures taken to prevent the increase in mass shooting in Sweden are presented.

[Self-rating scales reveal psychopathy]. / Självbedömningsskalor avslöjar psykopati.

Psychopathy is regarded as a dimensional concept--i.e., a person can be more or less psychopathic. This approach enables psychopathy to be measured with reliable, validated personality scales, and to be related to impairment of serontonergic function in the brain. Several personality inventories are described in the article, especially the Karolinska Scales of Personality, the Zuckerman Sensation Seeking Scales, form V, the Eysenck Personality Questionnaire, including an impulsiveness scale from the IVE (Impulsiveness-Venturesomeness-Empathy) inventory, and the old dimensional scale, the Marke-Nyman Personality Temperament scale based on the personality theory of Henrik Sjöbring. In this way both old and new, and both Swedish and foreign personality concepts are linked together. Personality scales are easy to use and enable better stability and validity of results to be attained.

Increased plasma concentrations of the 5-HT precursor amino acid tryptophan and other large neutral amino acids in violent criminals.

BACKGROUND: Aggression has been suggested to be related to abnormal brain 5-HT activity. This amine is synthesized in brain from tryptophan, which is transported through the blood-brain barrier in competition with other amino acids. The relationship between tryptophan and its endogenous amino acid competitors in plasma might thus influence the availability of tryptophan in the brain and consequently brain 5-HT activity. METHODS: Plasma amino acids were determined in 89 offenders who had committed various violent and non-violent crimes and in 14 healthy controls. RESULTS: Both tryptophan and its competitors were higher in offenders who had committed violent crimes compared both with non-violent offenders and with controls. No difference was, however, seen in the relationship between tryptophan and its competitors. CONCLUSIONS: The results support the contention that violent behaviour is related to biochemical deviations but could not explain a possible decreased brain 5-HT activity.