Per Lindqvist

Schizophrenia and assaultive behaviour: the role of alcohol and drug abuse

To assess the role of alcohol and drug abuse among schizophrenics with assaultive behaviour, we analysed case records of 38 patients who were responsible for a total of 71 violent offences between 1972 and 1986. They were identified from a population‐based cohort of 644 individuals with schizophrenia hospitalized in Stockholm County during 1971. Fourteen of the 38 offenders abused alcohol and/or drugs and another 7 were probable abusers. These figures are higher than previously reported as regards abuse among schizophrenics. Most of the offences were peformed by nonhospitalized patients who had been ill for many years. The nature of most of the violent incidents resembled that of offences committed by non‐psychotic individuals. Our findings give further evidence for the role of abuse and social disintegration in assaultive behaviour among persons with schizophrenia.

Teenage suicide cluster formation and contagion: implications for primary care

BackgroundWe have previously studied unintentional as well as intentional injury deaths among teenagers living in the four northernmost counties, forming approximately 55% of Sweden with 908,000 inhabitants in 1991. During this work, we found what we suspected to be a suicide cluster among teenagers and we also suspected contagion since there were links between these cases. In this present study, we investigate the occurrence of suicide clustering among teenagers, analyze cluster definitions, and suggest preventive measures.MethodsA retrospective study of teenager suicides autopsied at the Department of Forensic Medicine in Umeå, Sweden, during 1981 through 2000. Police reports, autopsy protocols, and medical records were studied in all cases, and the police officers that conducted the investigation at the scene were interviewed in all cluster cases. Parents of the suicide victims of the first cluster were also interviewed. Two aggregations of teenager suicides were detected and evaluated as possible suicide clusters using the US Centers for Disease Control definition of a suicide cluster.ResultsTwo clusters including six teenagers were confirmed, and contagion was established within each cluster.ConclusionThe general practitioner is identified as a key person in the aftermath of a teenage suicide since the general practitioner often meet the family, friends of the deceased, and other acquaintances early in the process after a suicide. This makes the general practitioner suitable to initiate contacts with others involved in the well-being of the young, in order to prevent suicide cluster formation and para-suicidal activities.

Hopeless patients? A study of illicit opiate users who drop out from in‐patient detoxification

Individual and treatment‐related factors associated with early self‐discharge were studied among illicit opiate users consecutively admitted for hospital detoxification (ITT = 68, n = 45). Only 20% of the drop‐outs had a detailed treatment plan, 20% participated in their own treatment planning, and none were enrolled in a methadone/buprenorphine programme at admission (compared with 60, 80, and 66%, respectively, of those retained in treatment). Having a treatment plan at intake improved the odds for planned discharge by 13 and perceiving fewer positive aspects of drug use increased the odds for drop‐out by 12.6. A configural frequency analysis (CFA) showed one significant type: patients with sketchy or no treatment planning at intake, no maintenance treatment, and a low score on positive aspects of drug use were 7.5 times more likely to drop out than expected. Lacking a close maternal relationship characterized patients in this type (83% compared with 31% of non‐types). Drop‐outs seem to have insecure attachment patterns, which make contact difficult with social services and substance abuse treatment providers. Future research should devise ways of establishing a working alliance with patients likely to drop out, as well as investigating management policies for this patient group.

Homicide offenders 32 years later – A Swedish population-based study on recidivism

BACKGROUND The literature on recidivism by homicide offenders is scarce despite its importance for individuals and for society. AIMS To establish the rate of seriously violent re-offending among homicide offenders and identify risk factors for such recidivism. METHODS A 1970s incident cohort of all homicide offenders, sane and insane, from two regions of Sweden (N = 153) was followed up until 2007 using data from the national crime register. RESULTS Ten per cent of the cohort (n = 15) re-offended. The mean time from index offence to recidivism was 9.4 years. Five people (3%) committed a further homicide, and it was established that another five (3%) offenders had killed before the index offence. Prospective risk factors for violent recidivism were young age, psychotic disorder, male victim, acquainted victim and intoxicated victim. CONCLUSIONS The prevalence of repeated homicide is higher than previously reported. Victim variables and mental disorder in conjunction with substance abuse appear to be two domains of particular significance for recidivism.

Psychosis and Homicide in Sweden—A Time Trend Analysis 1987—2006

Few studies have examined temporal changes in the contribution of psychosis to homicide offending. This research examines whether the incidence and the proportion of people with schizophrenia spectrum disorders, compared to all homicide offenders, have changed over a 20-year period in Sweden. All homicide offenders in Sweden from 1987 through 2006 were identified in the National Register for Criminal Convictions and linked on an individual level to the Central Archive of the National Board of Forensic Medicine, where data concerning individuals subjected to a forensic psychiatric examination in Sweden are registered. Offenders with a diagnosis of a schizophrenia spectrum disorder (F20-F29) formed the subgroup of offenders with psychosis. While the overall incidence of homicide did not change over time, both the incidence and the proportion of offenders with schizophrenia spectrum disorders decreased somewhat in relation to all homicide offenders. Although offenders with a schizophrenia spectrum disorder still comprise a disproportionately large share of all homicide offenders, their contribution to the overall incidence of homicide is at least not increasing in Sweden. Yet, it remains a significant problem that needs to be addressed by clinicians and researchers.

Violent behaviour by general psychiatric patients in Sweden - validation of Classification of Violence Risk (COVR) software

The objectives of the study are to report the 20-week base rate of violent behaviour in the community among a general psychiatric patient population from Stockholm and to establish the validity of a violence risk assessment software program, Classification of Violence Risk (COVR), in a European setting. Three hundred and thirty one patients at two psychiatric hospitals in Stockholm were interviewed upon discharge. Telephone interviews with the patients and collaterals were conducted 10 and 20 weeks later. The violent behaviour was also measured through a national criminal register. The allocation of patients into different risk groups according to COVR software was compared with the occurrence of actual acts of violence during the follow-up. The base rate of violent behaviour was 5.7% and a ROC-analysis showed that the AUC for COVR was 0.77. Since there were few patients in the high risk groups, the 95% confidence interval for the proportion of violent patients was wide. The base rate of violent behaviour is relatively low in Sweden and prediction is therefore difficult. The predictive validity of COVR software is comparable to other risk assessment tools.

Gender differences in re-offending among psychiatrically examined Swedish offenders.

BACKGROUND The gender gap for violent offending is narrowing in the general population. Substance abuse and mental health problems are known risk factors for criminality. While substance abuse treatment has been associated with reduced risk of re-offending, women seem less likely to engage than men. People misusing substances tend to be high users of emergency room (ER) services. Such use may be an indicator both of treatment failure for substance misuse and offending. Little is known about gender differences in this respect. AIMS This study aims to test for gender differences in re-offending, use of substance abuse treatment, and hospital ER visits among offenders referred for forensic psychiatric assessment in Sweden. METHOD The study used a longitudinal retrospective design. Data on all 31 women from a 2-year (2000-2001) cohort of serious offenders referred for forensic psychiatric assessment in Stockholm county, and 31 men from the same cohort, were extracted from forensic service and national records. Selection of the men was by initial random sampling followed by matching on age and substance misuse. The two resulting samples were compared on health service use and re-offending data between release and the census date (30 April 2004). RESULTS There were no gender differences for violent re-offending or for engagement in planned substance abuse treatment, in spite of longer time at risk for the men. Re-offending was reduced for women but not men who did not present in the ER with physical health problems. CONCLUSIONS Our study is limited by sample size, although it included all women referred to the specialist forensic psychiatric service over 2 years, but it does indicate that differences between men and women in this situation are likely, and worthy of further study. The only way of achieving adequate sample sizes is likely to be through multi-centre collaboration.

Suicidal drowning deaths in northern Sweden 1992-2009 : the role of mental disorder and intoxication

Suicides by drowning have received limited attention by researchers. A recent finding that almost one-third of all drowning deaths in Sweden were classified as suicide instigated this study. We identified 129 cases of suicide by drowning in Northern Sweden and analyzed the circumstances and the psychiatric history prior to the suicide. Information was obtained from autopsy, police and medical records, as well as from the National Inpatient Register. One-third of the suicide victims had previously attempted suicide and half of the victims had been hospitalized due to mental health problems. One-third of these had left the hospital less than one week before the suicide. Alcohol and psychoactive drugs were present in 16% and 62% of the cases, respectively. A history of mental disorder and previous suicide attempt (s), especially by drowning, is an ominous combination necessitating efficient clinical identification, treatment and follow-up if a complete suicide is to be prevented.

P02-54 - Is outpatient-based substance abuse treatment a predictor of re-offending and other outcomes among Swedish offenders subjected to psychiatric assessment?

Introduction: Substance abuse is associated with criminal recidivism. Substance abuse treatment has been found to correlate negatively with re-offending among treatment utilizers. However, for offe ...

S13-01 - Substance abuse treatment as a predictor of criminal recidivism among psychiatrically examined Swedish offenders

Background: Substance abuse is clearly associated with criminal recidivism among offenders with and without mental disorder. Treatment for substance abuse correlates with lower rates of re-offendin ...