Edberg Hanna, Chen Qi, Andiné Peter, Larsson Henrik, Hirvikoski Tatja
Department of Women's and Children's Health, Paediatric Neuropsychiatry Unit, Centre for Neurodevelopmental Disorders at Karolinska Institute (KIND), Karolinska Institute, Stockholm, Sweden.
Northern Stockholm Psychiatric Clinic, Region Stockholm, Stockholm, Sweden.
Front Psychiatry. 2020 Oct 23;11:573989. doi: 10.3389/fpsyt.2020.573989. eCollection 2020.
The current lack of knowledge about intellectual disability (ID) in forensic psychiatric contexts can compromise the legal certainty of these individuals during the medico-legal process. To address ambiguous results in previous literature, the aim of the current study was to estimate the prevalence of ID in a pre-trial forensic psychiatric settings. Moreover, as little is known about the characteristics of offenders with ID, we conducted a clinical characterization of individuals with and without ID being subject to forensic psychiatric assessment. Using data from several Swedish national registers, we conducted a population-based retrospective observational study on 8,442 individuals being subject to pre-trial forensic psychiatric assessments in Sweden in 1997-2013. We performed univariate analyses to compare the characteristics of individuals with ( = 537) and without ID ( = 7,905). The prevalence of ID was 6.4% in the Swedish pre-trial forensic psychiatric context during the observational period. Compared with individuals without ID, individuals with ID were younger at the time of assessment, had a lower educational level, and had less frequently started families. ID was associated with lower frequency of diagnosed psychotic and bipolar disorders. However, a similar prescription rate of antipsychotics, and a comparable rate of previous inpatient care was observed among individuals with and without ID. Individuals with ID had more often been prescribed anti-libidinal treatments often used for treating sexual disorders, although did not present a higher prevalence of sexual disorder. The prevalence of ID among pre-trial individuals being subject to forensic psychiatric assessment was more than twice as high as assumed in the general population. Our results suggest that individuals with ID received pharmacotherapy without clear indication. Remaining challenges in the clinical management of individuals with ID were indicated by the discrepancy between the occurrence of psychiatric diagnoses, pharmacological treatment patterns, and rates of inpatient care.
目前在法医精神病学背景下对智力残疾（ID）缺乏了解，可能会在法医学过程中损害这些个体的法律确定性。为了解决以往文献中模棱两可的结果，本研究的目的是估计审前法医精神病学环境中ID的患病率。此外，由于对ID罪犯的特征知之甚少，我们对接受法医精神病学评估的有ID和无ID个体进行了临床特征分析。利用瑞典几个国家登记处的数据，我们对1997 - 2013年在瑞典接受审前法医精神病学评估的8442名个体进行了基于人群的回顾性观察研究。我们进行了单变量分析，以比较有ID（=537）和无ID（=7905）个体的特征。在观察期内，瑞典审前法医精神病学背景下ID的患病率为6.4%。与无ID个体相比，有ID个体在评估时更年轻，教育水平更低，组建家庭的频率也更低。ID与诊断为精神病性和双相情感障碍的频率较低有关。然而，在有ID和无ID个体中观察到抗精神病药物的处方率相似，以及既往住院治疗率相当。有ID个体更常被开用于治疗性障碍的抗性欲治疗药物，尽管其性障碍的患病率并不更高。接受法医精神病学评估的审前个体中ID的患病率比一般人群中假设的患病率高出两倍多。我们的结果表明，有ID个体在没有明确指征的情况下接受了药物治疗。精神病诊断的发生率、药物治疗模式和住院治疗率之间的差异表明了ID个体临床管理中仍然存在的挑战。
