Effect of sex offenders treatment program on cognitive and emotional characteristics of mentally ill sex offenders.

This study assessed the effect of a 10-week cognitive behavior treatment program in 30 mentally ill sex offenders. The effect of the program was evaluated using the Interpersonal Responsiveness Index (IRI), UCLA Loneliness Scale (UCLALS), Coping Using Sex Inventory (CUSI), and Rape Myth Acceptance Scale (RMAS). Data were analyzed using the paired t-test. The ability of sex offenders to cope with sexual acts when they faced stressful situations and to accept the rape myth was significantly improved on CUSI (t = 2.09, p = 0.04) and RMAS (t = 5.45, p < 0.001). Feelings of isolation and the ability to empathize based on IRI (t = 0.62, p = 0.54) and UCLALS (t = 0.88, p = 0.38) were not significantly improved. To prevent recidivism, treatment for mentally ill sex offenders should focus on changes in their cognitive and emotional characteristics in addition to their main psychiatric illness.

Clinical features of parricide in patients with schizophrenia.

OBJECTIVE: This study aimed to investigate the factors associated with parricide in patients with schizophrenia who committed homicide. METHOD: Among patients with schizophrenia who were in the National Institute of Forensic Psychiatry between November and December 2007, 88 patients who committed homicides were enrolled; 59 had committed parricide, and 29 had killed strangers. Medical charts, written expert opinions, written records of police or prosecutors, and court decisions were reviewed. Direct interviews with patients were also conducted. RESULTS: Significant factors associated with parricide among homicidal patients with schizophrenia were living with the victim, female sex of the victim, and offense-provoking events including scolding, threatening forced hospitalisation, and forcing medication on the patient before the homicide. Capgras syndrome was present at a significantly higher rate in the parricide group than in the stranger group. Drug compliance at the time of the offence was low in both groups. CONCLUSIONS: Untreated psychotic symptoms such as Capgras syndrome, living with elderly parents, especially mothers, and conflicts caused by victims' scolding, threatening forced hospitalisation, and forcing medication on the patients are associated with parricide among homicide offenders with schizophrenia.

Homicide and bipolar I disorder: a 22-year study.

BACKGROUND: Non-serious offenses in manic phase have been mainly studied in patients with bipolar disorder. However, some authors reported that depressive phase is related with the violent and homicidal manifestations of bipolar disorder. AIMS: We investigated the characteristics of homicide by the polarity of mood episode in patients with bipolar I disorder. METHODS: Among the offenders who were sentenced to undergo treatment at the National Institute of Forensic Psychiatry from October 1987 to January 2008, a total 219 offenders whose final diagnoses were bipolar I disorder based on DSM-III-R and DSM-IV were selected. Retrospective medical chart review was performed for characteristics of mood episodes. Descriptions of offenders were supplemented by review of the written records of the police or prosecutors. RESULTS: The general rate of total offense was higher in the manic phase than in the depressive phase (86.8% vs. 13.2%). However, the rate of homicide was higher in the depressive phase than in the manic phase. The victims of homicide were more likely to be family members of the patients in depressive phase than in manic phases (96.2% vs. 63.9%, p=0.001). However, parricide was committed only in manic phases. Altruistic motivation of homicide was significantly higher in depressive phase (34.6% vs. 0%, p<0.001) whereas impulsivity was the most common one in manic phases. CONCLUSIONS: The risk of offenses, particularly homicide for family members, should not be overlooked in the depressive phases of bipolar I disorder.

Criminal manifestations of dementia patients: report from the national forensic hospital.

BACKGROUND/AIMS: Some dementia patients have profound behavioral and psychological symptoms which might cause legal violation. We illustrate clinical and criminal characteristics of dementia patients who had been incarcerated because of criminal activity. METHODS: The National Forensic Hospital is the only hospital-based correctional facility in the Republic of Korea which incarcerates criminals with psychiatric or neurological disease. Between May 2008 and April 2009, those patients who had been diagnosed with dementia in the National Forensic Hospital were included in the study. We reviewed their medical and legal reports. RESULTS: There were 7 dementia patients out of 752 patients, including 2 Alzheimer's disease (AD) patients, 1 vascular dementia patient, and 4 patients with alcohol-related dementia. Criminal behavior included simple larceny by the 2 AD patients, and multiple violent crimes in a drunken state by the other 5 patients. CONCLUSIONS: This study reported diverse criminal behaviors among dementia patients. Inebriation may be related to violent criminal behavior among some dementia patients.

Characteristics of Epilepsy Patients who Committed Violent Crimes: Report from the National Forensic Hospital.

BACKGROUND AND PURPOSE: We investigated the clinical and criminal characteristics of patients with epilepsy who had committed violent crimes in order to understand the mechanism of violence and to prevent future criminal activity. METHODS: We reviewed medical and legal reports of criminals with epilepsy who were incarcerated in the Korean National Forensic Hospital between October 2007 and September 2008. RESULTS: Of 761 criminals admitted to the National Forensic Hospital, 17 patients (2.2%) were diagnosed with epilepsy. All of them had localization-related epilepsy, and no patient reported an overt seizure attack around the time of a crime. Psychosis was present in eight patients, and seven patients were in a drunken state at the time of the crimes. There was a positive correlation between the patients' age at their first crime and their intelligence quotient score. CONCLUSIONS: These results suggest that most violent crimes take place during interictal periods, and diverse medical conditions, including inebriation, psychosis, and low intelligence, are associated with violent crimes among epileptic patients.

A closer look at depression in mothers who kill their children: is it unipolar or bipolar depression?

OBJECTIVE: The purpose of this retrospective study was to investigate the prevalence of bipolar depression and differentiate the factors that could predict bipolar disorder among filicidal depressive mothers. METHOD: Among the offenders who were sentenced to undergo treatment at the National Institute of Forensic Psychiatry, Gongju, Korea, for committing filicide or attempting filicide during 1987 to 2006, 45 women were selected whose final diagnoses at discharge were major depressive disorder or bipolar disorder based on DSM-III-R and DSM-IV criteria. Retrospective medical chart review was performed, mainly focusing on the prevalence rate of bipolar depression, including the rate of diagnostic change during admission. We also investigated the characteristic symptoms of depressive episodes that could predict bipolar disorder. RESULTS: At admission, in only 24.4% of the patients (N = 11) was bipolar disorder diagnosed. However, on the basis of diagnosis at discharge, a bipolar disorder prevalence rate of 73.3% (N = 33) was found. Of the patients with major depressive disorder at admission, 64.7% (N = 22) were subsequently reclassified as having bipolar disorder based on newly observed hypomanic or manic episodes during the admission period. The significant (p < .05) depressive symptoms at the time of filicide that could predict bipolar depression were the presence of postpartum-onset depression (95% CI = 1.45 to 160.88), psychotic symptoms (95% CI = 1.94 to 215.81), and nonaltruistic motivation for filicide (95% CI = 1.68 to 133.36). CONCLUSION: Our results suggest that mental health professionals should consider the possibility of bipolarity when they examine filicidal depressive mothers with postpartum-onset depression, psychotic symptoms, and nonaltruistic motivation for filicide.