Gender-Specific Differences in Depressive Behavior Among Forensic Psychiatric Patients

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.

Download Full-text

Suicide among Forensic Psychiatric Patients

Medicine Science and the Law ◽

10.1177/002580249303300209 ◽

1993 ◽

Vol 33 (2) ◽

pp. 137-143 ◽

Cited By ~ 3

Author(s):

C Johnson ◽

J Smith ◽

C Crowe ◽

M Donovan

Keyword(s):

Psychiatric Patients ◽

Care Staff ◽

Preventive Interventions ◽

Affective Psychosis ◽

Forensic Patients ◽

Forensic Psychiatric Patients ◽

History Of ◽

Secure Unit ◽

Forensic Psychiatric ◽

Commit Suicide

This paper examines the problem of suicide among patients discharged from a Regional Secure Unit. The stereotype that emerges is a young man with anti-social personality traits, suffering from an affective psychosis, with a history of substance abuse and impulsive violence directed both towards himself and others, who is alienated from care staff and social supports because of his provocative and uncooperative behaviour. In contrast with the general population, forensic patients are more likely to commit suicide using a violent method and are more likely to have a suicide verdict recorded by the coroner. The implications of these findings for treatment and preventive interventions are discussed.

Download Full-text

Augmentation of clozapine with amisulpride: an effective therapeutic strategy for violent treatment-resistant schizophrenia patients in a UK high-security hospital

CNS Spectrums ◽

10.1017/s1092852913000874 ◽

2013 ◽

Vol 19 (5) ◽

pp. 403-410 ◽

Cited By ~ 10

Author(s):

James E. Hotham ◽

Patrick J. D. Simpson ◽

Rosalie S. Brooman-White ◽

Amlan Basu ◽

Callum C. Ross ◽

...

Keyword(s):

Clinical Improvement ◽

Psychiatric Patients ◽

Case Series ◽

Metabolic Parameters ◽

Treatment Resistant ◽

High Security ◽

Forensic Psychiatric Patients ◽

Before And After ◽

History Of ◽

Forensic Psychiatric

ObjectiveClozapine is used in the management of treatment-resistant schizophrenia and is effective in reducing aggression; however a subgroup of patients is poorly responsive. For violent patients in this group, there is limited literature on the use of strategies to augment clozapine with other agents. Here we present a case series of 6 schizophrenia patients, within a high-security hospital, who have a history of serious violence and who were treated with clozapine augmented with amisulpride.MethodsWe reviewed case notes and health records for evidence of violence/aggression and positive factors such as engagement in activities, and Clinical Global Impression (CGI) scores were formulated. We also examined metabolic parameters before and after augmentation.ResultsAll 6 of the patients showed clinical improvement in symptoms and a reduction in their risk of violence to others. Five patients had a reduction in number of violent/aggressive incidents, and all patients showed improvement in engagement in occupational, vocational, and/or psychological work. Metabolic parameters were largely unchanged except for 1 patient whose Body Mass Index (BMI) increased. Five patients reported side effects as unchanged or improved.ConclusionThese schizophrenia patients with a history of violence showed clinical improvement and reduced aggression and violence with amisulpride augmentation of clozapine. To our knowledge, this is the first report of an antiaggressive benefit of this combination in forensic psychiatric patients. Further studies are warranted to establish the efficacy and anti-aggressive effects of amisulpride augmentation of clozapine.

Download Full-text

The Mentally Ill Offender: A Comparison of Prison Inmates, Forensic Psychiatric Patients, and General Psychiatric Patients

The Journal of Psychiatry & Law ◽

10.1177/009318538100900207 ◽

1981 ◽

Vol 9 (2) ◽

pp. 203-207

Author(s):

James M. Mullen ◽

Robert C. Reinehr

Keyword(s):

Mentally Ill ◽

Psychiatric Patients ◽

Population Characteristics ◽

Psychiatric Facility ◽

Forensic Patients ◽

Maximum Security ◽

Forensic Psychiatric Patients ◽

Patient Groups ◽

Health Institutions ◽

Forensic Psychiatric

The study examines the question of appropriate placement of forensic psychiatric patients, by comparing population characteristics of a penal institution, a general psychiatric hospital, and a maximum security forensic psychiatric facility. Results suggest that forensic patients resemble general psychiatric patients more closely than they resemble prisoners. In demographic areas the patient groups are quite similar and quite different from the prisoner group. The results of psychological testing are equivocal, but support the impression patient groups differ from prisoners. The study suggests courts are reasonably successful in identifying those offenders placed in mental health institutions rather than in a criminal justice setting.

Download Full-text

The Validation of the Megargee-Bohn Typology in African American and Caucasian Forensic Psychiatric Patients

Criminal Justice and Behavior ◽

10.1177/0093854895022003003 ◽

1995 ◽

Vol 22 (3) ◽

pp. 233-245 ◽

Cited By ~ 1

Author(s):

HEIDI E. HUTTON ◽

MICHAEL H. MINER

Keyword(s):

African American ◽

Ethnic Groups ◽

Psychiatric Patients ◽

Psychiatric Inpatients ◽

Forensic Patients ◽

Differential Validity ◽

Forensic Psychiatric Patients ◽

Caucasian Sample ◽

Caucasian Patients ◽

Forensic Psychiatric

This study examined whether the Megargee MMPI typology had differential validity for African American and Caucasian forensic psychiatric inpatients. We compared 516 African American and Caucasian patients in our four most common Megargee types across demographic, clinical, and forensic variables. Our findings indicate that the profile descriptions of types Charlie, Delta, How, and Item cannot be applied with equal confidence to African American and Caucasian forensic patients. Although certain demographic factors did not differ across ethnic groups, there were differences in clinical/forensic and hospital assault variables. In addition, the Caucasian sample showed the expected pattern of associations, whereas the African American sample did not.

Download Full-text

Early onset externalizing behaviors among forensic psychiatric patients: Identification in child and adolescent psychiatric services

Psychiatry Research ◽

10.1016/j.psychres.2021.114235 ◽

2021 ◽

pp. 114235

Author(s):

Emma Claesdotter-Knutsson ◽

Carl Delfin ◽

Natalie Laporte ◽

Märta Wallinius

Keyword(s):

Early Onset ◽

Externalizing Behaviors ◽

Psychiatric Patients ◽

Child And Adolescent ◽

Psychiatric Services ◽

Forensic Psychiatric Patients ◽

Forensic Psychiatric

Download Full-text

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.

Download Full-text

Impact of Clozapine versus Haloperidol on Conditional Release Time and Rates of Revocation in a Forensic Psychiatric Population

Journal of Pharmacy Technology ◽

10.1177/875512250201800403 ◽

2002 ◽

Vol 18 (4) ◽

pp. 182-186 ◽

Cited By ~ 2

Author(s):

Steven C Stoner ◽

Jessica S Wehner Lea ◽

Beth M Dubisar ◽

Kathleen Roebuck-Colgan ◽

David M Vlach

Keyword(s):

Psychiatric Patients ◽

Psychiatric Rehabilitation ◽

Release Time ◽

Conditional Release ◽

Forensic Population ◽

Forensic Patients ◽

Forensic Psychiatric Patients ◽

Axis I ◽

Forensic Psychiatric ◽

The Impact

Background Clozapine remains the cornerstone of treatment for treatment refractory schizophrenia. Clozapine has been shown to improve quality of life and cognitive functioning and to reduce hospital days in psychiatric patients. The impact of clozapine in a forensic population of psychiatric patients has not been studied. Methods This study is a naturalistic, retrospective database analysis of forensic patients hospitalized at the Northwest Missouri Psychiatric Rehabilitation Center from January 1, 1990 to August 1, 1999 who were treated with clozapine or haloperidol. Patients were either court ordered for hospitalization as having been found not guilty by reason of insanity or as incompetent to proceed to trial. Results Data from 84 patients (69 male, 15 female) were included in the analysis. The primary Axis I diagnoses were substance abuse (n = 61) and schizophrenia (n = 46). Patients had been treated with haloperidol (n = 78) and clozapine (n = 21), and some had received each agent as monotherapy during their course of treatment (n = 15). Assault (n = 22), armed criminal action (n = 18), and burglary (n = 18) were the primary forensic reasons for admission. Of those eligible to obtain a conditional release, 33% of haloperidol-treated patients and 38% of clozapine-treated patients obtained their conditional release on those medications. Haloperidol-treated patients were more likely to have their conditional release revoked (58.8%) versus those treated with clozapine (0%). Clozapine-treated patients were also more likely to stay on conditional release for longer periods of time. Global Assessment of Functioning (GAF) scores improved in both treatment groups; however, of 15 patients converted from haloperidol to clozapine, 93% (n = 14) saw improvements in GAP scores. Conclusions Clozapine and haloperidol effectively reduce psychosis and aggression. In our study, clozapine-treated patients were more likely to obtain a conditional release and stayed on conditional release for longer periods of time. Although the need exists to study this patient population more closely from a longitudinal standpoint, one may suspect that these findings represent a potential decrease in healthcare costs for the treatment of forensic psychiatric patients.

Download Full-text

The role of psychosocial treatment in decreasing of future violence behavior risk in forensicly treated psychiatric patients

European Psychiatry ◽

10.1016/s0924-9338(11)72488-9 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 783-783

Author(s):

S. Jonovska ◽

V.Š. Jengić ◽

L. Safner ◽

G. Bošković ◽

S. Zudenigo

Keyword(s):

Psychiatric Patients ◽

Violent Behavior ◽

Psychosocial Treatment ◽

Violence Risk ◽

Forensic Psychiatric Patients ◽

Forensic Treatment ◽

Aggression Questionnaire ◽

Schizophrenic Group ◽

Forensic Psychiatric ◽

In The Beginning

The main aim of this study was to establish to what extent psychosocial treatment as a part of complex, multicomponent forensic treatment has an influence on decreasing of the future violence behavior risk in population of forensic psychiatric patients. We examinated 13 patients treated on Department of Forensic Psychiatry of Psychiatric Hospital Rab in Rab, Croatia. 9 of them were males and 4 of them females, 25–60 years of age, all of them were compulsory hospitalized because of committed criminal act connected with violent behavior. All of them have diagnosis of schizophrenic group of diseases with different duration of forensic treatment (from few months to few years). During 2010. all of them participated in psychosocial programe workshops once a week, for 6 months.MethodsViolence Risk Screening-10 (V-RISK-10), subjective measure of the programme chairmen performed in the beginning and in the end of the programme. The Aggression Questionnaire and Daily Spiritual Experience Scale as self-assesment scales were performed in the end of the programme. Results point on decreasing of V-RISK-10 results in the end of the programe in all participants. Interested observation was that mentioned results and those on self-assesment scales were not always been correlated positively. We also proved negative correlation between aggressivity and spirituality. As a conclusion, we have indications to believe that is real to expect that comining psychosocial treatment with targeted psuchopharmacological interventions could leed to decreasing the risk of future violent bihevior in forensicly treated psuchiatric patients.

Download Full-text