van Dongen Josanne, Buck Nicole, Van Marle Hjalmar
Erasmus University Rotterdam, Rotterdam, The Netherlands.
Crim Behav Ment Health. 2015 Apr;25(2):88-98. doi: 10.1002/cbm.1910. Epub 2014 Mar 27.
Previous studies have led to suggestions that there are at least three sub-types of offenders with schizophrenia, but these have not previously been examined simultaneously in one sample.
The aims of this study were to investigate categorisation of offenders with psychosis as early or late starters or late first offenders, and test the hypotheses that, compared with non-offenders with psychosis, early starters would be characterised by low educational or occupational achievement, negative childhood experiences and early substance use, whereas positive psychotic symptoms would characterise late starters or late first offenders.
A retrospective file study was conducted, yielding 97 early starters, 100 late starters and 26 late first offenders identified from a specialist inpatient forensic mental health assessment service and 129 non-offenders identified from general psychiatric services in the same geographic region, all with schizophreniform psychoses.
We found little difference between early and later starters in terms of measured antecedents, but substance misuse was up to 20 times less likely among late first offenders. Persecutory and/or grandiose delusions were more strongly associated with each offender group compared with non-offenders, most so with late first offenders.
Our findings underscore the importance of treating delusions--for safety as well as health. Childhood antecedents may be less important indicators of offender sub-types among people with psychosis than previously thought. When patients present with grandiose or persecutory delusions over the age of 35 years without co-morbid substance misuse disorders, but with a history of childhood neglect and low educational achievement, particular care should be taken to assess risk of violence.
以往的研究表明，至少存在三种精神分裂症罪犯亚型，但此前尚未在同一个样本中对这些亚型进行同时研究。
本研究旨在调查患有精神病的罪犯被分类为早期或晚期犯罪者或晚期初犯，并检验以下假设：与患有精神病的非罪犯相比，早期犯罪者的特征是教育或职业成就低、童年经历负面以及早期使用药物，而晚期犯罪者或晚期初犯的特征是存在阳性精神病症状。
进行了一项回顾性档案研究，从一家专科住院法医精神健康评估服务机构中识别出97名早期犯罪者、100名晚期犯罪者和26名晚期初犯，并从同一地理区域的普通精神科服务机构中识别出129名非罪犯，所有这些人均患有精神分裂症样精神病。
我们发现，在测量的前期因素方面，早期和晚期犯罪者之间几乎没有差异，但晚期初犯滥用药物的可能性要低20倍。与非罪犯相比，被害妄想和/或夸大妄想与每个罪犯组的关联更强，与晚期初犯的关联最为显著。
我们的研究结果强调了治疗妄想对于安全和健康的重要性。对于患有精神病的人来说，童年前期因素可能不像之前认为的那样是罪犯亚型的重要指标。当患者在35岁以上出现夸大或被害妄想，没有合并物质滥用障碍，但有童年期被忽视和教育成就低的病史时，应特别注意评估暴力风险。
