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

Abstract

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.