Schizophrenia spectrum disorders, substance misuse, and the four-facet model of psychopathy: The relationship to violence (original) (raw)
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Psychopathy (PCL-R) as a predictor of violent recidivism among criminal offenders with schizophrenia
Law and Human Behavior, 2000
Hare's Psychopathy Checklist-Revised (PCL-R) was used to test the hypothesis that psychopathy predicts violent recidivism in a cohort subjected to forensic psychiatric investigation and consisting of male violent offenders with schizophrenia (N ϭ 202). Psychopathy was assessed with retrospective file-based ratings. Mean follow-up time after detainment was 51 months. Twenty-two percent of the offenders had a PCL-R score Ն26 (cutoff), and the base rate for violent recidivism (reconvictions) during follow-up was 21%. Survival analysis revealed that psychopathy was strongly associated to violent recidivism (log-rank ϭ 17.71, df ϭ 1, p Ͻ 0.0001). The area under the curve (AUC) of the receiver operating characteristics (ROC) of PCL-R total score to predict violent recidivism varied between different time frames from .64 to .75. Cox regression analyses revealed that other potential risk factors could not equally well or better explain violent recidivism in the cohort than psychopathy as measured by PCL-R.
Personality and Mental Health, 2012
We examined the relationship between psychopathic traits and substance abuse and violent victimization in 94 community patients meeting DSM-IV criteria for schizophrenia spectrum disorders in contact with public mental health services in Victoria, Australia. Data on violence and victimization were collated from multiple sources and combined to categorize patients into victims of serious violence (VV; n = 74) and those who were not victims of serious violence (NVV; n = 20) groups. The VV group had higher rates of unemployment and previous violence but did not differ from the NVV on current symptom ratings. The VV group has significantly higher substance abuse and psychopathy scores, but only psychopathy score significantly contributed to the prediction of victimization. All psychopathy facets were reasonably good predictors of victimization status, but the antisocial facet contributed most to the prediction of victimization. A better understanding of the role and contribution of antisocial (particularly psychopathic) traits in violent victimization in mentally ill populations is needed to better inform community management plans.
Psychopathy and Violent Behavior Among Patients With Schizophrenia or Schizoaffective Disorder
Psychiatric Services, 1999
M any persons held in correctional and forensic psychiatric facilities are psychopaths (1). Psychopathy is associated with criminality (2-4) and specifically with violent crime. Com-pared with nonpsychopathic offenders, psychopaths have more criminal charges per year spent unincarcerated and more convictions for violent crimes; they are also responsible for more violence in prisons (5). The as-Objective: Although a strong association between violence and psychopathy has been demonstrated in nonpsychotic forensic populations, the relationship between psychopathy and violence among patients with schizophrenia has not been thoroughly explored. Patients with and without a history of persistent violent behavior were compared for comorbidity of psychopathy and schizophrenia or schizoaffective disorder. Methods: Violent and nonviolent patients were identified through reviews of hospital charts and records of arrests and convictions. The Psychopathy Checklist: Screening Version was administered to 51 patients, 26 violent patients and 25 matched nonviolent patients. Analysis of variance was used as the principal statistical method for comparing violent and nonviolent groups. Results: Mean psychopathy scores were higher for violent patients than nonviolent patients. Five of the violent patients (19 percent) had scores exceeding the cutoff for psychopathy, and 13 (50 percent) scored in the possible psychopathic range. All of the nonviolent patients scored below the cutoff for possible psychopathy. Higher psychopathy scores were associated with earlier age of onset of illness and more arrests for both violent and nonviolent offenses. Conclusions: The comorbidity of schizophrenia and psychopathy was found to be higher among violent patients than among nonviolent patients. Violent patients with schizophrenia who score high on measures of psychopathy may have a personality disorder that precedes the emergence of psychotic symptoms, or they may constitute a previously unclassified subtype of schizophrenia, characterized by early symptoms of conduct disorder symptoms and persistent violent behavior. (Psychiatric Services 50:787-792, 1999)
Risk factors for violence among patients with schizophrenia
Clinical Psychology Review, 2011
Studies of birth cohorts show evidence of greater risk of violence among patients with schizophrenia compared to the general population. However, the contribution of schizophrenia to violence is heavily debated and remains unclear. This debate has spurred research whose focus can be associated with one of the following areas: psychotic symptoms, personality disorders (in particular psychopathy), mentalizing abilities, substance abuse and demographic factors. The aim of the current review is to evaluate the predictive role of these risk factors in the occurrence of violence among patients with schizophrenia. We identified two different trajectories for violent behavior in schizophrenia: one pertains to patients with no prior history of violence or criminal behavior and for whom positive symptoms appear to explain violent behavior, and another where personality pathology, including psychopathy, predict violence, regardless of other symptomatology associated with schizophrenia. Furthermore, emergent data suggest that specific mentalizing profiles can be associated with the occurrence of violence in schizophrenia, an issue that warrants further consideration in future research.
Personality, Schizophrenia, and Violence: A Longitudinal Study
Journal of personality disorders, 2017
The aims of this study were (a) to investigate the presence of clinically significant personality traits and personality disorders (PD) in patients living in residential facilities, with or without a history of violence (69 and 46, respectively); and (b) to investigate any associations between clinically significant personality traits and PDs, aggression, impulsivity, hostility, and violent behavior during a 1-year follow-up. The most frequent primary diagnoses were schizophrenia (58.3%) and PD (20.9%). Those with a history of violence demonstrated more antisocial and alcohol dependence features and lower depressive PD symptoms than the control group. Hostility levels, antisocial symptoms, and drug dependence, as well as a Structured Clinical Interview for DSM-IV Axis II diagnosis of PD, predicted aggressive and violent behavior during follow-up. The study confirms the relevance of assessing PDs both to evaluate the risk of violent behavior and to plan appropriate preventive and tre...
International Journal of Advanced Research, 2021
Study of the relationship between mental disorder and violent behavior is critical both from a public health perspective and for the proper planning and development of mental health services.However, the complex contribution of clinical, historical and environmental risk factors for violence in persons with schizophrenia remains unclear. The aim of the study was to identify clinical and social risk factors for violence in patients with schizophrenia and schizophrenia spectrum disorders (SSD) using a case-control design. Cases were defined as patients with SSD who had committed at least one act of offence in the past (94 patients wereenrolled from forensic psychiatricward). Controls were genderand age matched patients with SSD who had never committed violent acts (106 patients from general psychiatric services).A standard set of instruments was used to assess patients exposure to a variety of risk factors. Data were collected through patient interviews and medical records.Study resul...
Acta Psychiatrica Scandinavica, 2013
JRP. Comparing violence in schizophrenia patients with and without comorbid substance-use disorders to community controls. Objective: This study examined crime and violence in patients with schizophrenia with and without comorbid substance-use disorders. Method: A case-linkage design was used to compare patterns of violence and offending between 4168 schizophrenia patients drawn from a statewide public mental health register, both with and without comorbid substance-use disorders, and a randomly selected community control group who had never been diagnosed with schizophrenia. Results: Schizophrenia patients were significantly more likely than controls to be guilty of violent and non-violent offences, and to have been involved in family violence. Even schizophrenia patients without comorbid substance-use disorders had a significantly elevated risk of violence; this group were more than twice as likely as controls to have a violent conviction. The elevation of violence risk in schizophrenia patients was higher in females (OR = 8.59) than males (OR = 2.25). Conclusion: The increased risk of violent offending in schizophrenia cannot be solely attributed to the effects of comorbid substance misuse, although comorbidity certainly heightens the likelihood of criminality. In addition to offending, people with schizophrenia are more likely than community controls to come to the attention of police via their involvement in family violence incidents. Schizophrenia is a particularly strong risk factor for violence in females.
Relationships between dimensional factors of psychopathy and schizotypy
Frontiers in Psychology, 2013
Existing research has suggested that comorbid psychopathy may explain one trajectory of violent behavior in a subset of individuals with schizophrenia. However, it remains unclear which specific traits and symptoms are responsible for this relationship and whether it is limited to clinical and/or forensic categories, or if it reflects a dimensional relationship found in the general population. Therefore, the aim of this study was to examine differential relationships between specific factors of psychopathy and schizotypy in a non-psychiatric and non-forensic sample. Two hundred and twelve undergraduate students (50% female) completed the Schizotypal Personality Questionnaire (SPQ) and the Psychopathic Personality Inventory-Revised (PPI-R). After controlling for age and sex, regressions showed that the total SPQ score was positively related to the total PPI-R score and the Self-Centered Impulsivity factor, and negatively related to the Fearless Dominance factor. Self-Centered Impulsivity was positively related to all three SPQ factor scores, with the strongest relationship found with the Cognitive-Perceptual factor. In contrast, Fearless Dominance was negatively related to only the Interpersonal and Disorganized factors of the SPQ, with the strongest relationship found with the Interpersonal factor. Findings suggest that the comorbidity of schizotypy and the self-centered impulsivity aspect of psychopathy is not limited to extreme discrete populations, but exists in a more dimensional manner within a non-psychiatric sample. In addition, it appears that schizotypy is negatively related to the fearless dominance aspect of psychopathy, which appears to be a novel finding. Results provide preliminary findings that may have implications for developing appropriate prediction, assessment, and treatment techniques for violent behavior in schizophrenia-spectrum disorders.