Kris Goethals

Unraveling sexual associations in contact and noncontact child sex offenders using the single category - implicit association test

Previous studies found associations between children and sex in child sex offenders (CSOs) using the Implicit Association Test (IAT). We used a modification of this task, the Single Category–Implicit Association Test (SC-IAT) to unravel child-sex associations in CSOs. Using the SC-IAT, we were able to test whether CSOs indeed hold stronger child-sex associations relative to adult-sex associations, compared to adult sex offenders and nonoffenders. Furthermore, we examined whether contact CSOs differed from noncontact CSOs in their child-sex associations. The hypothesis that CSOs would have stronger child-sex associations, relative to their adult-sex associations, than adult sex offenders and nonoffenders was confirmed. No difference between contact CSOs and noncontact CSOs was found. Although the Sex SC-IAT was able to distinguish CSOs from nonoffenders, the sensitivity and specificity of the test was poor (AUC of .65) and needs refinement. The results of this study support the existence of a child-sex association as a distinctive characteristic of CSOs. These findings are discussed in the context of theories on deviant cognitions in CSOs and risk for sexual offending.

The Role of Substance Abuse in Psychotic Versus Personality Disordered Offenders Detained Under the Dutch Entrustment Act (TBS): An Exploratory Study

Mentally disordered patients that abuse drugs or alcohol have a larger number of criminal convictions. Early starters who had their first conviction before the age of 18, especially, more often have a diagnosis of substance abuse and are more often intoxicated at the time of the offense compared to late starters. The present study involved four groups of Dutch patients (n = 137): three groups of violent offenders (psychotic and personality disordered patients) and one group of non-delinquent psychotic patients from general psychiatry. All data were retrieved retrospectively. The results showed that early starters were intoxicated more often, started with substance abuse at an earlier age and more often had a diagnosis of substance abuse at the time of the index offense than late starters. Personality disordered offenders were intoxicated more often and more often had a prior diagnosis of substance abuse at the time of the offense than psychotic offenders. To a limited extent, psychotic offenders with a diagnosis of a substance-related disorder or intoxication at the time of the offense had a more extensive criminal history than personality disordered offenders. Substance abuse has an aggravating effect on criminogenic behavior, depending on the age at first conviction and diagnosis.

Diagnostic Comorbidity in Psychotic Offenders and Their Criminal History: A Review of the Literature

There is growing evidence that there is a relationship between a psychotic disorder and violent behavior. Diagnostic comorbidity of a psychotic disorder with substance abuse, a personality disorder or psychopathy increases the likelihood of violence. The aim of this review is to examine the literature about the relationship between a psychotic disorder and violence, and about comorbidity of a psychotic disorder with substance abuse, a personality disorder and/or psychopathy. A search of www.PubMed.com and www.PsychInfo.com for the period 1990–2006 yielded 1942 articles. Ultimately, however, only 73 articles remained after eliminating those on irrelevant topics. Results showed that the roles of substance abuse, the presence of a personality disorder, or a high score on the revised psychopathy checklist are confirmed as important risk factors by many authors. This review revealed a high degree of agreement that possible comorbidity in schizophrenic offenders should be mentioned routinely in scientific research as it has an essential effect on the development of the offenders illness.

Temporal Relationship Between Psychotic Disorder and Criminal Offense: Review of the Literature and File Review Study

During the past 15 years, a small body of literature has accumulated regarding the temporal relationship between schizophrenia and crime. Many forensic patients have a history of psychiatric care before committing an offense, but such care was often inadequate. Comorbid disorders such as substance abuse and an antisocial personality disorder and/or psychopathy may be responsible for earlier referral of psychotic patients to psychiatric care in connection with the resultant early behavioral problems. In connection with the inadequate care for forensic patients, it is possible that a period of untreated psychosis occurs more often and is of longer duration. The purpose of the present study was to assess these findings. We considered three groups: two groups of forensic patients with a psychotic disorder, with or without a comorbid personality disorder, who have committed a serious violent offense, and a third group of psychotic patients from the general psychiatric population who have not committed a serious violent offense. Retrospective data were collected and the sociodemographic, substance abuse, diagnostic (DSM-IV) and psychiatric history variables were compared. The score on the PCL-SV was taken into account. Psychotic patients detained under the Dutch Entrustment Act (i.e., TBS-detainees) with a comorbid personality disorder began their psychiatric career before committing a violent offense. A long time was found between the first admission and the TBS-offense. Psychopathy and substance abuse influenced these intervals. No difference was found between psychotic TBS-detainees and psychotic patients in general psychiatry with regard to the duration of untreated psychosis. The recognizability of the various groups of psychotic patients in general psychiatry could have a preventive effect if the comorbidity is examined.

Possible correlations between the deficient affective experience and negative symptoms of psychosis: An exploratory study in (forensic) psychiatric patients

BACKGROUND Deficient affective experience (DAE), the affective and perhaps fundamental component of psychopathy, has some resemblance to the core affective disturbances of schizophrenia. There has, however, been little attempt to test relationships between these concepts, but this could be useful because of the high prevalence of schizophrenia among people in forensic mental health services and evidence that the DAE may be a useful predictor of violent behaviour. AIMS Our primary aim was to explore possible correlations between DAE and negative symptoms of schizophrenia and to test the hypotheses that the DAE would differentiate people with and without personality disorder co-morbidity in a sample with psychosis and, separately, people with main diagnoses of personality disorder or schizophrenia. METHOD On the basis of an interview and a review of institutional files, DAE total and facet scores were calculated and compared with scores on the negative symptom scale of the Positive and Negative Syndrome Scale among forensic and general psychiatric patients. Partial correlation and rank order coefficients were calculated. RESULTS We found no correlation between total DAE scores and total negative Positive and Negative Syndrome Scale scores among patients with psychosis, suggesting that the concepts probably do not overlap. Our hypotheses on diagnostic associations with the DAE were partially sustained. DAE scores differentiated psychosis and personality disorder groups but did not differentiate psychosis groups with and without personality pathology. CONCLUSIONS AND IMPLICATIONS This study, using typical clinical samples, suggested that one aspect of the affective disturbance of schizophrenia has little in common with the deficient emotional experience of psychopath. Measurement of DAE is unlikely to help detect co-morbid personality disorder among people with psychosis, but given our small sample size and the rarity of study in this field, further research would be warranted, perhaps also including a measure of incongruity of affect.

Psychotic Symptoms and Prior Use of Psychiatric Services in Psychotic Offenders Detained Under the Dutch Entrustment Act (TBS): An Exploratory Study

According to the literature, most forensic psychotic patients have been in contact with general psychiatry before the index offense. However, the services received are not always in agreement with their needs. Comorbidity with a conduct disorder or antisocial personality disorder can influence the first admission to psychiatry. Four groups of patients with a history of severe violent offenses, but not sex offenses, were recruited from forensic psychiatric hospitals (TBS-hospitals) and one general hospital (N= 137). The design was retrospective, all information was extracted from existing files, and a list of sociodemographic, psychiatric, and criminological variables was used. A SPSS statistical package was used to analyze the data. It was hypothesized that psychotic offenders had more positive and negative psychotic symptoms and that they made less use of psychiatric services and psychotropic drugs, compared to psychotic patients in general psychiatry. Psychotic offenders had received less treatment, both in childhood and as adult, compared to psychotic patients in general psychiatry. General psychiatry could prevent psychotic patients tfrom becoming offenders, while forensic psychiatry can be of significant assistance to general psychiatry in learning how to perform risk assessment and how to deal with the antisocial characteristics in psychotic patients.

Circumstantial Risks in Psychotic Offenders and their Criminal History: A Review of the Literature

The authors present the results of a review of the literature between 1990 and 2006. A search of www.PubMed.com and www.PsychInfo.com yielded 1942 articles using the following search terms: (crime/violence) AND (psychosis/schizophrenia) AND (substance abuse); (crime/violence) AND (psychosis/schizophrenia) AND (personality disorder/psychopathy); or (crime/violence) AND (psychosis/schizophrenia) AND (youth). Ultimately, however, only 29 articles remained after eliminating the articles on irrelevant topics. This review covers the literature on the influence of the circumstantial risks to which violent psychotic patients were exposed since childhood. The temporal relationship between a psychotic disorder and criminality, prior psychiatric care, the victims, psychosocial and circumstantial problems, and behavior problems in childhood and adolescence are discussed, in that order. Studies into the time of the first offense in relation to the onset of psychosis, diagnosis and first admission yielded a variety of results. Most of the forensic patients had had previous contact with general psychiatry before becoming a forensic patient, but the quality of the psychiatric care was not always appropriate. The victims of schizophrenic patients were mostly persons that they knew. Besides substance abuse, social functioning was viewed as an important risk factor. Externalizing behavior in childhood and adolescence was seen most often in future schizophrenics who later committed offenses. In summary, it can be stated that a psychotic disorder should never be seen separately from the circumstantial risk factors.

Targets of violence and psychosocial problems in psychotic offenders detained under the Dutch Entrustment Act

During the past 16 years, a small body of literature has accumulated regarding the sociodemographic characteristics of offenders with a major mental disorder (MMD). The general conclusion is that the combination of having a MMD and living in meagre, stressful circumstances may be much more predictive of the characteristics of social networks, relationships, and the risk of violence than any clinical factor alone. The aim of the present study was to test these findings. Four groups of patients were considered: three groups of offenders who had committed a very violent crime and had a psychosis or personality disorder or a combination of both, and one group from a general psychotic population. Retrospective data were collected and sociodemographic, diagnostic (DSM-IV), and psychiatric history variables were compared. There was a tendency for those detainees with a personality disorder to have victimised their partners, and for those detainees with psychosis to have victimised ‘business relations’, such as caregivers. Psychotic offenders had not experienced fewer problems than personality-disordered detainees in the two years before the offence. Psychotic detainees are often excluded from the care they need, but when they finally get care, their caregivers are at risk of violence.

Penitentiary mental health care in Belgium

The new century has ushered new innovations in mental health care in Belgian jails and prisons, following a century of inaction and neglect. Despite repeated pleas by several leading Belgian forensic psychiatrists, the political authorities did not see through the necessary reforms in order to bridge the severe gap between regular psychiatric care and penitentiary forensic psychiatric care. The primary reason for this situation is that, despite an extensive public health system, Belgium has not extended equitable care to prisoners. It remains the responsibility of the Justice Department to organize health care within jails and prisons but it never assumed this duty at an acceptable level; consequently, there is no quality control of the somatic or psychiatric care in jails and prisons.

Multi-agency Working

Multi-agency working in forensic mental health is defined as the coming together of people from different professional backgrounds, organisations and services, sometimes with varying primary purposes but with the common aim of improving public safety and decreasing an individual’s risk of harm to others. This chapter examines multi-agency working and describes systems in place for this in Germany (the round table), the United Kingdom (multi-agency public protection arrangements), the Netherlands (safety houses) and Denmark (police, social services and psychiatry cooperation). The potential advantages of multi-agency working include a sharing of the burden of responsibility, clarity on responsibilities, engagement with difficult people that might otherwise be rejected by mental health services, a reduction in recidivism, encouragement of informal collaboration and development of relationships, case review and broadening the perspective from a particular professional standpoint alone, improvement in continuity of care, promotion of sharing of information on a proportional basis and shared educational opportunities. Potential disadvantages include breach of confidentiality, continued intrusion into an individual’s life and cost of multi-agency working both in terms of infrastructure financing and opportunity costs.