Registered criminality and sanctioning of schizophrenia patients.

BACKGROUND: Patients with schizophrenia have been shown to have an increased risk of criminality, especially violent crimes. AIMS: The aim of the current study was to describe the pattern of crimes committed by Danish patients with schizophrenia and examine the sanctions given for crimes in relation to the different periods in the patients' lives: not yet known to the psychiatric hospital system, known to the system but not yet diagnosed with schizophrenia, and after being diagnosed with schizophrenia. METHODS: Information from the Danish Psychiatric Central Research Register was correlated with data from the Danish National Crime Register. RESULTS: One of the more prominent findings was that 16% of patients diagnosed with schizophrenia receive a prison sentence or a suspended prison sentence, despite the fact that Denmark is a co-signatory of the European Prison Rules and should treat, rather than imprison, individuals with schizophrenia. CONCLUSION: The findings suggest that greater alertness is needed in the judicial system for individuals diagnosed with schizophrenia.

The association between psychopathology of first-episode psychosis patients within the schizophrenia spectrum and previous offending.

Patients with schizophrenia have been shown to have an increased risk of criminality. The aim was to describe possible psychopathological differences between schizophrenia spectrum patients with and without a criminal career before first-episode psychosis. In a multi-centre study, 16 psychiatric treatment centres included and rated 477 patients with first-episode psychosis over a 2-year period on socio-demography, the Positive and Negative Syndrome Scale, OPerational CRITeria checklist, Global Assessment of Functioning, Premorbid Adjustment Scale and Self-report Insight Scale for psychosis. Data were linked with data concerning criminal and psychiatric history. No key characteristics were found to assist the early detection of criminal persons before first psychiatric hospital contact for a psychotic incident. However, when adjusted for sex, age, abuse, living conditions, marital status, employment status and education, a primarily positive symptomatology was associated with a prior criminal career. The premorbid level of functioning and several function parameters were also significantly associated with criminal history. There are significant differences in psychopathology between schizophrenia spectrum patients with and without a criminal career before first-episode psychosis, and a better screening procedure in the judicial system could detect these individuals earlier and make adequate treatment possible.

Forensic psychiatric patients among immigrants in Denmark--diagnoses and criminality.

The purpose of this study is to analyse a sample of immigrant forensic psychiatric patients and to compare them with Danish patients. Of the 326 forensic patients in Copenhagen, 111 were immigrants or descendants of immigrants. The sample was broken down according to area of origin, age, gender and ethnic status. The data have been analysed by Poisson regression with the background population as an offset variable. Of the patients of non-Danish ethnicity, a significantly higher ratio was diagnosed with schizophrenia and a lower ratio was diagnosed with personality disorders compared with Danes. Iranians accounted for a higher ratio than did other minority groups, whereas patients from Western Europe/USA were not different from Danes. The higher ratio of forensic schizophrenic patients of non-Danish ethnicity cannot be explained by social factors or substance abuse. Migration increases the age-adjusted risk (ARR) of becoming schizophrenic (ARR=2.7). We found the ARR of becoming a male forensic schizophrenic patient among immigrants/descendants to be 2.8, i.e. the same as that caused by migration as such. Violence and schizophrenia are associated, and this explains the fact that the ratio of immigrants/descendants having committed violence exceeds that of Danes. Non-violent crimes are more equally distributed among ethnic groups and seem to be associated with common criminogenic factors. Arson is mainly committed by older schizophrenic patients of Danish ethnicity. The risk of an individual immigrant and Danish schizophrenic patient exhibiting criminal behaviour is the same. Schizophrenia is a criminogenic factor in violence, but not in non-violent crimes. The differences between the various ethnic groups could be related to selection caused by both immigration and emigration.

[Psychosis and crime]. / Psykose og kriminalitet.

The number of forensic patients has increased dramatically in Denmark as well as in many other countries during the last three decades. The patients predominantly suffer from schizophrenia. The offences committed by the patients are often violence. The increasing number of forensic patients has been linked to a decreased use of inpatient treatment. In Denmark, most forensic patients are treated by general psychiatrists for whom the growing number of such patients is a major challenge. General psychiatrists require more training and knowledge within this area.

Mental disorders and charges of violent offences. A study of male adolescent remand prisoners.

This study describes associations between mental disorders and charges of violence among remanded adolescents. 100 15-17 year old boys from East Denmark, consecutively remanded during one year, were interviewed with SCAN, K-SADS and SCID-II to obtain past year ICD-10 diagnoses. There was no statistically significant association between the occurrence of a violent charge and mental disorders in general (OR=1.02, 95% confidence interval (CI) [0.24; 4.38]). An association was found between violent charge and non-Danish ethnicity (OR=7.58, [1.60; 35.92]). Previously reported association between violence and mental disorder among adults were not replicated in this male adolescent remand population. A developmental hypothesis is proposed.

[Forensic patients in Denmark--2000-2004]. / Retspsykiatriske patienter--udvikling 2000-2004.

INTRODUCTION: In Denmark the number of forensic patients increased exponentially from 1980 to 1999, with an annual growth rate of 6.8%. In 2000 some psychiatric orders became time-limited. This study maps out the development from 2000 to 2004. MATERIALS AND METHODS: The material includes forensic patients under supervision by a probation officer. Since 1977, the Department of Prisons and Probation has registered their prevalence and, since 1989, also the incidence and the lifting of previously established orders. The material is representative and has been corrected according to new legislation. The monthly prevalence is analysed 1980-2004, the monthly incidence 1989-2004. RESULTS: The incidence increased exponentially from 1989 to 1999, with an annual growth rate of 6.2%, the annual growth rate from 2002 to 2004 being 12.8% (p=0.078). The whole period 1989-2004 showed a constantly increasing growth rate (p<0.001). The prevalence decreased from 2000 to 2001, as many orders were lifted due to new legislation. The prevalence in 2002-2004 shows an annual growth rate of 11.0%. The difference between the growth rates of incidence and prevalence 2002-2004 is not significant. Thus the number of forensic patients is now increasing exponentially, with an annual growth rate of 11% CONCLUSION: Increasing criminality among schizophrenic patients has been established in many countries. The main reason is supposed to be deinstitutionalization, which probably applies to Denmark as well. Today forensic patients occupy about 20% of the total number of psychiatric beds in Denmark, and whatever the reasons for the growing number are, this fact, in combination with the decreasing number of available beds, points towards a disastrous development for the mentally ill.

Violence of young criminals predicts schizophrenia: a 9-year register-based followup of 15- to 19-year-old criminals.

Violent and aggressive behavior in preschizophrenia adolescents has been described in several studies. Our aim was to investigate the extent to which violent conviction in late adolescence predicted later schizophrenia in a cohort of young criminals. We performed a 9-year register-based followup of a complete national cohort of young convicted criminals. A total of 780, 15- to 19-year-old subjects identified in 1992 were followed up in 2001 with register linkage of the Danish Psychiatric Central Register, the Danish National Criminal Register, and the Danish National Cause of Death Register. Analyses with Cox regression were performed to identify predictors of later schizophrenia. We found at followup that 3.3 percent of the cohort had been diagnosed with schizophrenia and 4.5 percent with any psychosis. Conviction of violence in late adolescence was significantly associated (odds ratio = 4.59 [95% confidence interval (1.54; 13.74)]) with future diagnosis of schizophrenia. Violent behavior can thus be seen as part of the preschizophrenia phase of young criminals.

Incipient offending among schizophrenia patients after first contact to the psychiatric hospital system.

The study examines how age, sex and substance use disorder are associated with the risk of committing a criminal offence. The study explicitly examines the risk after the first contact to the psychiatric hospital system and after the diagnosis of schizophrenia for those with no previous criminal record; the association between previous non-violent criminality and later violent criminality is also analysed. The study sample comprised 4619 individuals ever diagnosed with schizophrenia. All solved offences were accessible. Data were analysed using Cox's regression. Schizophrenic men had twice the risk of schizophrenic women of committing both violent and non-violent offences. A registered substance use disorder increased the risk 1.9- to 3.7-fold, depending on the starting point for the analyses, while increasing age on first contact or when diagnosed with schizophrenia diminished the risk. Previous non-violent criminality increased the risk for later violent criminality 2.5- to 2.7-fold, depending on the starting point for the analyses. The results suggest that the psychiatric treatment system can play an active role in preventing criminality among individuals with schizophrenia. The preventive measures should be based on a thorough assessment including criminal history at intake and alertness toward young psychotic men with substance use disorders and especially if they also have a criminal history.

[Crimes committed by mentally ill persons in the years 1977-1999. Development, number and causes]. / Kriminalitet begået af psykisk syge 1977-1999. Udvikling, antal og årsager.

INTRODUCTION: In line with many other countries, Denmark has reorganised psychiatric care with closure of 50% of the psychiatric beds in favour of community mental health. Parallel to this reorganisation the number of forensic patients has increased. MATERIAL AND METHODS: In Denmark, the majority of forensic patients are under supervision by a probation officer. As from 1977, The Department of Prison and Probation has registered the monthly prevalence of forensic patients, from 1989 also the monthly incidence and decrease. These data have been used to analyse the trends in the number of forensic patients. RESULTS: The number of forensic patients increased from 297 in 1980 to 1134 in 1999, the increase in prevalence being exponential with an annual growth rate of 6.79%. The incidence figures showed an exponential increase with an annual growth rate of 5.96% (95% confidence interval 4.76%-7.27%). The annual growth rate for the decrease is 6.18%. Thus, the three growth rates do not differ, meaning that the increasing number of forensic patients is the result of an increasing intake. DISCUSSION: The growing number of mentally ill offenders cannot be explained by changes of the Danish penal law concerning mentally abnormal offenders nor by changes in administrative or diagnostic practice. The number of reported crimes in Denmark has remained unchanged from 1987. The main reason for the exponential growth rate is an increasing number of schizophrenic patients committing crimes. It is concluded that deinstitutionalisation is the main reason for this development.

The temporal relationship between schizophrenia and crime.

BACKGROUND: Little is known about the temporal relationship between illness onset and the possible beginning of a criminal career among people with schizophrenia, even though criminality, especially violent criminality, has been shown to be more common among people with schizophrenia than among people in general. AIM: The aim of this study was to analyse the temporal relationship between registered crime and contact to the psychiatric hospital system. METHOD: This is a register-based study merging data on the psychiatric career with criminal records. RESULTS: Among the males with schizophrenia, 37% started a criminal career and 13% had committed first violent crime before first contact with the psychiatric hospital system. CONCLUSION: The criminality committed before first contact to the psychiatric hospital system is substantial, especially among males with schizophrenia.