A Case-Controlled Study of Cognitive Behavioral Therapy for Patients with Schizophrenia Having Violence-Related Crime / 대한정신분열병학회지

OBJECTIVES: Despite remarkable development of pharmacotherapy for schizophrenia, some patients continuously have had violence problems. The violence of psychotic patients is recently becoming the focus of the attention. The aim of this study is to investigate the influence of Cognitive Behavioral Therapy (CBT) on patients with schizophrenia having violence related history. METHODS: 15 Patients with schizophrenia spectrum disorder of crime history were treated with individual CBT for 12 sessions, and assessed with 4 scales (Korean version of Aggression Questionnaire, Korean version of the Barratt Impulsiveness Scale-11-Revised, Beck Cognitive Insight Scale and Positive and Negative Syndrome Scale) to evaluate anger, impulse, insight and clinical symptoms respectively at baseline and post treatment. The comparison group consisted of 15 patients with schizophrenia spectrum disorder of crime history. They were also assessed with the same scales during the same period. RESULTS: Although impulsivity is not changed significantly after treatment, but there was significant improvement in clinical symptom, insight and aggression, especially self-reflectiveness and anger respectively. CONCLUSION: CBT can be one of the good therapeutic tools for patients with schizophrenia having violence problems in that it reduces aggression and enhances insight of patients with schizophrenia spectrum disorder.

Legal Features of Mental Disorders among Sexual Offenders without Paraphilia / 대한법의학회지

The aim of this study was to evaluate the legal features of sexual offenders with mental disorders without paraphilia. Patients admitted to Korea Forensic Hospital from 1994 to 2012 (n = 193) were reviewed for diagnosis, crime, legal responsibility, readmission (number of admissions), hospitalizations, criminal record, and education level. Psychotic subjects were often declared not guilty because of insanity and avoided legal responsibility, but had long admission periods and fewer criminal records. Mentally retarded subjects also had long admission periods and fewer criminal records, but commited more sexual offenses against victims aged 13 and younger. The substance abuse group had extensive criminal records, shorter admission periods, and frequent admissions. Subjects with personality disorders and others committed relatively more violent crime with injuries, rather than simple sexual offenses. Treatment and social concerns suitable to each diagnosis are required to address sexual offenses associated with diverse legal characteristics.

The Characteristics of Recidivism in Sex Offenders by STATIC-99 and KSORAS / 대한법의학회지

OBJECTIVES: The aim of this study was to evaluate the risk of recidivism in sex offenders according to the sociodemographic factors, IQ, diagnosis by using Static-99 and KSORAS. METHODS: A total of 48 sex offenders were enrolled. Among them, 44 offenders were rated by Static-99, 41 offenders were evaluated by KSORAS. All the information was collected by reviewing medical records and written records of prosecutors or police retrospectively. RESULTS: In Static-99 and KSORAS, young adults tend to commit more recidivism than late adults. Single offenders have high rates of recidivism than married offenders in Static-99. In KSORAS, mental retardation patients have a tendency to commit more recidivism than schizophrenia patients. CONCLUSION: We should not overlook that specific condition of sex offenders (young adults, single, mental retardation) can have more possibility of recidivism.

Clinical Features of Parricide in Patients with Schizophrenia / 신경정신의학

OBJECTIVES: This study aimed to describe the demographic, clinical and offense characteristics of the patients with schizophrenia who committed parricide. This study also investigated the risk factors of parricide by comparing with characteristics of stranger killers to prevent the tragic offense. METHODS: The sample consisted of 88 schizophrenic patients who committed homicide, 59 of them committed parricide and 29 of them killed strangers. Medical chart review regarding demographic and clinical characteristics as well as offense characteristics was conducted. The information that was difficult to be obtained through chart review was acquired by direct interview. RESULTS: Parricide group had earlier age of onset, more conflicts with the victims, more violence history toward victims and more offense provoking events than stranger killing group. Parricide group showed higher rate of past treatment than that of stranger killing group. However drug compliance at the time of offense was low in both groups. Offense provoking events in the parricide group included blaming, threatening a forced hospitalization or medication toward patients. The most common psychiatric symptoms associated with homicide were threat/control override (TCO) symptoms, delusional perception, commanding auditory hallucination and especially with parricide, Capgras syndrome (CS). CONCLUSION: Interaction between psychotic symptoms such as TCO, CS and underlying emotion toward victims are likely to be associated with parricide. Mental health professionals are expected to play an important role in preventing this tragic offense by active history taking of the violence and effective management with active caregiver education/intervention of intrafamilial conflicts.

Effect of Sex Offenders Treatment Programme on Cognitive and Emotional Characteristics of Mentally Ill Sex-Offenders / 신경정신의학

OBJECTIVES: This study was investigated to prove the effectiveness of Cognitive Behavior Treatment Program in mentally ill sex offenders and to be used as basic data for development of optimized treatment program for mentally ill sex offenders. METHODS: Cognitive Behavior Treatment Program was carried out over 10 weeks for 30 mentally ill sex offenders. With Interpersonal Responsiveness Index (IRI), UCLA Loneliness Scale (UCLALS), Coping Using Sex Inventory (CUSI) and Rape Myth Acceptance Scale (RMAS), the effectiveness of the treatment programme was evaluated. The data was analyzed with paired t-test. RESULTS: The results with 23 subjects showed no significant score changes after treatment program in IRI and UCLALS. However, there was a statistically significant improvement in the scores of CUSI and RMAS. CONCLUSION: Despite several limitations, this study showed significant effects of Cognitive Behavior Treatment Program on mentally-ill sex offenders. Therefore, treatment focused on the changes of cognitive and emotional characteristics of sex offenders along with the treatment for main psychiatric illness should be provided for mentally ill sex offenders to prevent recidivism. More studies to develope optimized treatment programme for mentally ill sex offenders are needed in the future.