Wolf Viviane, Mayer Juliane, Steiner Ivonne, Franke Irina, Klein Verena, Streb Judith, Dudeck Manuela
Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Clinic Duesseldorf, Heinrich Heine University Duesseldorf, Duesseldorf, Germany.
Department of Forensic Psychiatry and Psychotherapy, kbo-Isar-Amper-Clinic Taufkirchen (Vils), Taufkirchen (Vils), Germany.
Front Psychiatry. 2023 Jun 30;14:1203824. doi: 10.3389/fpsyt.2023.1203824. eCollection 2023.
Schizophrenia is associated with a heightened risk of violent behavior. However, conclusions on the nature of this relationship remain inconclusive. Equally, the empirical evidence on female patients with schizophrenia spectrum disorders (SSD) is strongly underrepresented.
For this purpose, the first aim of the present retrospective follow-up study was to determine the risk factors of violence in a sample of 99 female SSD patients discharged from forensic psychiatric treatment between 2001 and 2017, using three different measures of violence at varying time points (i.e., violent index offense, inpatient violence, and violent recidivism). Potential risk factors were retrieved from the relevant literature on SSD as well as two violence risk assessment instruments (i.e., HCR-20 V3, FAM). Further, we aimed to assess the predictive validity of the HCR-20 V3 in terms of violent recidivism and evaluate the incremental validity of the FAM as a supplementary gender-responsive assessment.
The given results indicate strong heterogeneity between the assessed violence groups in terms of risk factors. Particularly, violence during the index offense was related to psychotic symptoms while inpatient violence was associated with affective and behavioral instability as well as violent ideation/intent, psychotic symptoms, and non-responsiveness to treatment. Lastly, violent recidivism was related to non-compliance, cognitive instability, lack of insight, childhood antisocial behavior, and poverty. Further, the application of the HCR-20 V3 resulted in moderate predictive accuracy (AUC = 0.695), while the supplementary assessment of the FAM did not add any incremental validity.
This article provides important insights into the risk factors of violence among female SSD patients while highlighting the importance of differentiating between various forms of violence. Equally, it substitutes the existing evidence on violence risk assessment in female offenders with SSD.
精神分裂症与暴力行为风险增加有关。然而，关于这种关系本质的结论仍无定论。同样，关于精神分裂症谱系障碍（SSD）女性患者的实证证据也严重不足。
为此，本回顾性随访研究的首要目的是，在99例2001年至2017年间从法医精神病治疗机构出院的女性SSD患者样本中，使用不同时间点的三种不同暴力测量方法（即暴力指数犯罪、住院期间暴力和暴力再犯）来确定暴力风险因素。潜在风险因素从关于SSD的相关文献以及两种暴力风险评估工具（即HCR-20 V3、FAM）中获取。此外，我们旨在评估HCR-20 V3在暴力再犯方面的预测效度，并评估FAM作为补充的性别针对性评估的增量效度。
给定结果表明，在风险因素方面，评估的暴力组之间存在强烈异质性。特别是，指数犯罪期间的暴力与精神病症状有关，而住院期间暴力与情感和行为不稳定以及暴力观念/意图、精神病症状和治疗无反应有关。最后，暴力再犯与不依从、认知不稳定、缺乏洞察力、童年反社会行为和贫困有关。此外，HCR-20 V3的应用导致了中等预测准确性（AUC = 0.695），而FAM的补充评估并未增加任何增量效度。
本文提供了关于女性SSD患者暴力风险因素的重要见解，同时强调了区分各种形式暴力的重要性。同样，它用关于SSD女性罪犯暴力风险评估的现有证据进行了补充。
