Substance use among male forensic patients

There is a widespread use of substances abuse which might cause violence, suicide, interpersonal conflicts, lawsuits, psychiatric commitment, and even crimes. Psychiatrists are under increasing pressure to develop strategies to address the problem of coexisting criminal behaviour, addiction, and mental illness. The aim of this study was to examine the association between demographic profile, psychiatric symptomatology and substance use in forensic psychiatric inpatients, and to consider the treatment needs and opportunities for intervention among the same sample.MethodologyA retrospective study was done on patients admitted to the department for Forensic Psychiatry at the Razi Hospital from 1996 to 2016, initially jailed for detention and drug consumption and judged irresponsible by reason of insanity. Data were collected by record review.ResultsThirty-two patients were included in the study. Mean age was 27.81 years. Thirty-six percent of the participants were illiterate and 45% were single. More than half of the subjects (54%) had personal psychiatric history and 27, 27% had family history of psychiatric problems. About one third (31.81%) of participants had judicial background: 33% were arrested for public drunkenness, 44% were arrested for violence, and 22% were arrested for theft. Concerning the diagnosis, 45% were suffering from schizophrenia, 22.77% were diagnosed with personality disorder and 27.27% of them would not have any mental trouble. About 50% of the patients did not follow up with treatment.ConclusionAddictive disorders are authentic psychopathological disorders. Effective treatment is hindered by the paucity of research on clinical application of treatment models for addictive disorders in this population.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Forensic care in Germany

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.051 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S61-S61

Author(s):

H. Dressing ◽

H.J. Salize

Keyword(s):

Psychiatric Hospital ◽

Psychiatric Hospitals ◽

Epidemiological Data ◽

Mentally Ill Offenders ◽

Legal Regulations ◽

Forensic Patients ◽

Penal Law ◽

Forensic Psychiatric ◽

Competing Interest ◽

Legal Frameworks

Although the idea that offenders suffering from a mental disorder must primarily be considered as ill and should therefore be exempted from punishment is of considerable antiquity legal frameworks and key concepts, which are applied in this field, differ widely in European Union member States. The respective legal regulations and epidemiological data of Germany will be presented.In German penal law the question of the guilt of an offender is of central significance. Legal regulations on the placement and treatment of mentally ill offenders in a forensic psychiatric hospital are subsumed under the section “Measures on improvement and safety”. Section 63 of the German penal law provides for the temporally unlimited commitment to a forensic- psychiatric hospital.In accordance with section 64 of the German penal law addicted offenders can be committed to a detoxification center for a period of up to two years. The available epidemiological data show a clear increase in the admissions to forensic psychiatric hospitals and to detoxification centers since beginnings of the 1990s. Recently the German parliament passed a new law. The aim of the new law is to strengthen patients’ rights and to diminish the number of forensic patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Risk classes of patients diagnosed with substance use disorders in Dutch forensic psychiatric centers

Journal of Forensic Practice ◽

10.1108/jfp-08-2020-0036 ◽

2021 ◽

Vol 23 (1) ◽

pp. 39-52

Author(s):

Michele Schmitter ◽

Jeroen Vermunt ◽

Eric Blaauw ◽

Stefan Bogaerts

Keyword(s):

Substance Use ◽

Substance Use Disorders ◽

Latent Class ◽

Mental Health Problems ◽

Treatment Approach ◽

Future Research ◽

Content Type ◽

Forensic Patients ◽

Axis I ◽

Forensic Psychiatric

Purpose Given the complex association between substance use disorders (SUD), comorbid mental health problems and criminal recidivism in forensic patients, homogenous patient classes can contribute to a refined treatment. This paper aims to construct those classes in forensic patients (N = 286) diagnosed with SUD, unconditionally released between 2004 and 2013 of one of ten Dutch forensic psychiatric centers. Design/methodology/approach Retrospective data were derived from electronic patient files. Classes were based on the Dutch risk assessment tool, the Historisch Klinisch Toekomst-Revisie (Historical Clinical Future–Revised [HKT-R]) and identified by means of explorative Latent Class Analysis in Latent Gold version 5.1. In a three-step approach, posterior class memberships were related to external variables (i.e. diagnoses, type of drug and type of offence). Findings Four classes were identified that differ in the risk of recidivism, as well as Axis I and II diagnoses and type of drug consumption. Practical implications This study informed on the heterogeneity of forensic patients with SUD and identified four homogenous classes that differ in important variables for the treatment approach. Based on these classes, a more refined treatment approach can be developed. Possible treatment approaches are discussed, but future research is needed to provide evidence. Originality/value This study is the first to identify classes within forensic patients with SUD and, therefore, sets the first step to develop a tailored treatment approach based on characteristics informative for treatment.

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Forensic psychiatric expertise of patients with anti-social personality

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.909 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S592-S592

Author(s):

M. Turki ◽

N. Charfi ◽

M. Maalej Bouali ◽

J. Ben Thabet ◽

N. Zouari ◽

...

Keyword(s):

Violent Behavior ◽

Epidemiological Studies ◽

University Hospital ◽

School Level ◽

Addictive Behaviors ◽

Psychiatric Expertise ◽

History Of ◽

Forensic Psychiatric ◽

Competing Interest ◽

High Crime

IntroductionEpidemiological studies in the general population confirm the indisputable link between criminological dangerousness and mental disorders especially anti-social personality, which increase clearly the prevalence of violent behavior.AimTo dress socio-demographic, clinical and medico-legal profile of offenders, with anti-social personality, in forensic psychiatric examination.MethodsIt was a retrospective study of a series of 195 patients with antisocial personality (DSM-IV). They were examined, during the period, from 2009 to 2013, on the occasion of a penal expertise in the department of psychiatry C in the Hedi Chaker university hospital, Sfax, Tunisia.ResultsThe mean age of patients at the offense moment, was 29.58 years, with a sex ratio of 26.85. Among them, 66.2% were single, 49.2% had a primary school level and 41% had no profession. Between the patients, 58.5% lived in urban area and 38.5% in a high crime area. Addictive behaviors were reported in 80% of cases. Self-injury behaviors were noted in 33.8% of offenders. Psychiatric histories were reported in 66.2%, and 25.6% of patients have been already hospitalized in psychiatry department. 64.1% had already committed forensic acts, and 36% had been imprisoned at least once. The current offense was: homicide 16.9%; sexual offense 9.2%; violence 18.5%; theft 30.2%. The offense was related to impulsivity (40%) or utilitarian purpose (39%).ConclusionA young single man with no profession, a limited educational attainment and a history of impulsive behaviors, such is the profile most frequently encountered among offenders with anti-social personality. Interventions for reducing forensic behavior should focus on those social and clinical characteristics.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Multi-morbidity: Psychosis early childhood adversity and substance use within homeless people

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.827 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S21-S21

Author(s):

M. Krausz

Keyword(s):

Mental Illness ◽

Substance Use ◽

Risk Factor ◽

Homeless People ◽

Childhood Adversity ◽

Housing First ◽

Persistent Mental Illness ◽

History Of ◽

Competing Interest ◽

Early Trauma

Homelessness is the most visible indicator for social marginalization and vulnerability. It is a risk factor for subsequent health threats and especially individuals with a history of trauma, substance use and severe persistent mental illness are at high risk to loose their homes, jobs and social networks.The Canadian At Home/Chez Soi study aimed to better understand the entanglement of homelessness and mental illness and possible strategies to provide care to the most vulnerable. In 5 Canadian centers, over 2000 patients were included and randomized to different intervention arms based on a housing first approach.Early trauma and foster care were as rampant as poly substance use, which explains a significant increase in mortality too.Disclosure of interestThe author has not supplied his declaration of competing interest.

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Whole-Exome Sequencing to Identify Potential Genetic Risk in Substance Use Disorders: A Pilot Feasibility Study

Journal of Clinical Medicine ◽

10.3390/jcm10132810 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2810

Author(s):

P. V. AshaRani ◽

Syidda Amron ◽

Noor Azizah Bte Zainuldin ◽

Sumanty Tohari ◽

Alvin Y. J. Ng ◽

...

Keyword(s):

Substance Use ◽

Family History ◽

Exome Sequencing ◽

Whole Exome Sequencing ◽

Substance Use Disorders ◽

Feasibility Study ◽

Genetic Variants ◽

Addictive Disorders ◽

Whole Exome ◽

History Of

Genetics intersects with environmental, cultural, and social factors in the development of addictive disorders. This study reports the feasibility of whole-exome sequencing of trios (subject and two family members) to discover potential genetic variants in the development of substance use disorders (SUD). Family trios were recruited from the National Addictions Management Service in Singapore during the 2016–2018 period. Recruited subjects had severe alcohol use disorder (AUD) or opioid use disorder (OUD), with nicotine dependence (ND) and a family history of addictive disorders. Demographic characteristics and severity of addiction were captured. Whole-exome sequencing (WES) and analysis were performed on salivary samples collected from the trios. WES revealed variants in several genes in each individual and disruptive protein mutations in most. Variants were identified in genes previously associated with SUDs, such as Pleckstrin homology domain-containing family M member 3 (PLEKHM3), coiled-coil serine-rich protein 1 (CCSER1), LIM and calponin homology domains-containing protein 1 (LIMCH1), dynein axonemal heavy chain 8 (DNAH8), and the taste receptor type 2 member 38 (TAS2R38) involved in the perception of bitterness. The feasibility study suggests that subjects with a severe addiction profile, polysubstance use, and family history of addiction may often harbor gene variants that may predispose them to SUDs. This study could serve as a model for future precision medicine-based personalized interventional strategies for behavioral addictions and SUDs and for the discovery of potentially pathogenic genetic variants.

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Gender and immigrant status differences in the treatment of substance use disorders among US Latinos

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.453 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S196-S196

Author(s):

K. Alvarez ◽

B. Cook ◽

F. Montero Bancalero ◽

Y. Wang ◽

T. Rodriguez ◽

...

Keyword(s):

Substance Use ◽

Healthcare System ◽

Substance Use Disorders ◽

Immigrant Status ◽

Treatment Needs ◽

Patient Gender ◽

Adequate Care ◽

Lower Treatment ◽

Female Immigrants ◽

Competing Interest

US Latinos have higher rates of substance use disorders (SUDs) than Latinas, but Latinas face substantial barriers to treatment and tend to enter care with higher SUD severity. Immigrant Latinas may face greater barriers to care than native-born despite lower overall SUD prevalence. This study aimed to identify how SUD treatment needs of Latinos are addressed depending on patient gender and immigrant status within an urban healthcare system serving a diverse population.MethodsData from electronic health records of adult Latino/a primary care patients (n = 29,887 person-years) were used to identify rates of SUD treatment in primary and specialty care. Treatment characteristics and receipt of adequate care were compared by gender and immigrant status.ResultsTobacco was the most frequently treated substance followed by alcohol and other drugs. Forty-six percent of SUD patients had a comorbid psychiatric condition. Treatment rates ranged from 2.52% (female non-immigrants) to 8.38% (male immigrants). Women had lower treatment rates than men, but male and female immigrants had significantly higher treatment rates than their non-immigrant counterparts. Receipt of minimally adequate outpatient care varied significantly by gender and immigrant status (female non-immigrants 12.5%, immigrants 28.57%; male non-immigrants 13.46%, immigrants 17.09%) in unadjusted and adjusted analyses.DiscussionResults indicate overall low prevalence of SUD treatment in the healthcare system. Low rates of minimally adequate care evidence the challenge of delivering integrated behavioral healthcare for Latinos with SUD. Results also demonstrate gender and immigrant status disparities in an unexpected direction, with immigrant women receiving the highest rates of adequate care.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Neurobiological Mechanisms of Problem Gambling and Treatment

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.135 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S26-S26

Author(s):

A. Goudriaan ◽

R. van Holst ◽

T. van Timmeren

Keyword(s):

Substance Use ◽

Pathological Gambling ◽

Cue Reactivity ◽

Addictive Disorders ◽

Dsm 5 ◽

The Past ◽

Neurobiological Research ◽

Competing Interest ◽

And Personalized Medicine

Background and aimsIn the past decade, neurobiological research on pathological gambling has flourished. Based on neurobiological similarities between pathological gambling and substance use disorders and similarities in genetics, diagnostic criteria, and effective treatments, pathological gambling was the first behavioral addiction to be included in the DSM-5 within the revised category Substance-related and addictive disorders.In this presentation novel findings from gambling research in our research group focusing on the role of impulsivity, anticipation towards monetary outcomes, and the interaction between stress and cue reactivity will be presented, with a focus on new functional MRI results. An overview will be given on the concepts of impulsivity and compulsivity in pathological gambling and relevant neurocognitive and neuroimaging findings. Implications of neurobiological research for novel intervention research, such as in neuromodulation studies and personalized medicine will be highlighted.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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The Relationships Of Clinical, Socio-demographic and Criminal Factors in a Sample of Forensic Psychiatric Patients

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1689 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S464-S464

Author(s):

A. Sileikaite ◽

A. Germanavičius ◽

I. Česnienė

Keyword(s):

Substance Abuse ◽

Psychiatric Patients ◽

Criminal History ◽

Substance Abuse Problem ◽

Forensic Patients ◽

Violent Offending ◽

Violent Criminal ◽

Forensic Psychiatric Patients ◽

Forensic Psychiatric ◽

Competing Interest

IntroductionThe relationship between clinical factors and both psychosocial and criminal history characteristics among forensic psychiatric patients entering treatment in Lithuania has not been well explored.AimsThe aims and objectives of this presentation are:– to overview the clinical, socio-demographic and criminal factors in a Lithuanian sample of forensic psychiatric patients;– to demonstrate which factors were significant to violent criminal behaviour;– to address some main concerns and issues of risk assessment processes.MethodsData were collected from 325 forensic psychiatric patients’ files in one forensic psychiatric hospital in Lithuania. A sample consisted of 36 (11%) females and 289 (89%) males. The average age of patients was 41.7 years (SD = 14.0).ResultsPsychosis was the most common psychiatric diagnosis. The substance abuse problem was common in this population as well. The results of the logistic regression show that increase in patients’ substance abuse and their age was significantly associated with violent offending.ConclusionsThe study stressed an urgent need for further research of forensic patients in Lithuania.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Gender-Specific Differences in Depressive Behavior Among Forensic Psychiatric Patients

Frontiers in Psychology ◽

10.3389/fpsyg.2021.639191 ◽

2021 ◽

Vol 12 ◽

Author(s):

Judith Streb ◽

Elena Ruppel ◽

Anne-Maria Möller-Leimkühler ◽

Michael Büsselmann ◽

Irina Franke ◽

...

Keyword(s):

Beck Depression Inventory ◽

Externalizing Behaviors ◽

Psychiatric Patients ◽

Depression Symptoms ◽

Forensic Patients ◽

Symptoms Of Depression ◽

Forensic Practice ◽

Forensic Psychiatric Patients ◽

History Of ◽

Forensic Psychiatric

BackgroundWomen are almost twice as likely to develop depression than men, but men commit suicide more often. One explanation for this paradox is that current depression inventories do not fully capture typical male symptoms of depression. Several studies showed that most depression symptoms in men are masked by externalizing behaviors, such as aggressiveness, addiction, and risky behavior. Here, we explored the differences in depression symptoms between men and women in a forensic psychiatric sample.MethodsWe screened 182 forensic psychiatric patients and selected a matched sample (21 women and 21 men). External symptoms of depression were assessed with the Gender-Sensitive Depression Screening (GSDS) and internal symptoms with the Beck Depression Inventory Revision.ResultsAlthough externalizing behaviors were similar in both groups, we found a significant relationship between external and internal depression symptoms only in men. In addition, male forensic patients with a history of suicide had higher scores in the GSDS, whereas female patients with a history of suicide had higher scores in the Beck Depression Inventory Revision.DiscussionThe finding that the GSDS detected depression symptoms in men indicates that this instrument might be useful for developing assessments to prevent suicide in forensic practice.

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State patients who committed violent crimes and were admitted to Weskoppies Hospital from 2005 to 2014: Profiles and trends

South African Journal of Psychiatry ◽

10.4102/sajpsychiatry.v26i0.1416 ◽

2020 ◽

Vol 26 ◽

Author(s):

Zukiswa T. Dewet ◽

Carla Kotzé ◽

Funeka Sokudela

Keyword(s):

Substance Use ◽

Sexual Assault ◽

Mentally Ill ◽

Psychiatric Treatment ◽

Future Research ◽

Violent Crimes ◽

Crime Patterns ◽

History Of ◽

Record Review ◽

Over Time

Background: Most of the available literature focus on characteristics of violent offenders and trends of crime patterns in the general population. The crime trends in the population of those who may be mentally ill have not been well described.Aim: To describe the profiles and trends of mentally ill persons who committed violent crimes prior to admission as state patients.Setting: The study was conducted at Weskoppies Psychiatric Hospital.Method: A retrospective record review of state patients admitted between 2005 and 2014 was conducted to describe demographic, clinical, forensic and victim profiles of state patients admitted from 2005 to 2014. Trends over time were also assessed.Results: Hundred and seventy state patient files were reviewed. The majority were males (91.43%), with a history of substance use (55.0%) %), previous psychiatric treatment (46.4%), and diagnosed with a psychotic disorder (82.1%). The 10 year trend showed that murder was the leading charge during 2006 and 2007. It was surpassed by sexual assault crimes as the most common charge after 2007, except for 2009 when murder was again the most common. From 2010 onward, sexual assault remained the most common offence leading to admission as a state patient.Conclusion: This study found changes over time in crime patterns of state patients who committed murder and sexual assault. State patients may have different criminal patterns than the general public. This together with the high rates of substance use and previous psychiatric treatment can be important focus areas for future research.

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