ABSTRACT

The PhD dissertation was carried out at the Psychiatric Centre, Glostrup, in collaboration with the Clinic of Forensic Psychiatry, Ministry of Justice and the Research Centre for Prevention and Health, Glostrup. It covers two published articles and three manuscripts.

The crime rate among schizophrenia patients is higher than in the general population and it is steadily increasing despite criminality in the general population being stagnant. The increasing crime rate is a problem for society as well as for the mentally afflicted and his or her family. The schizophrenic has to fight not only the disease but also the stigma associated with criminality or being seen as a potential offender.

In a register-based study (n = 4619) the temporal relationship between committed crimes and the acknowledgement by the Danish mental health system of the psychiatric illness was studied. It is relevant for judging when a preventive effort should be launched. Thirty-seven per cent of all the schizophrenic men had started a criminal career before the first psychiatric contact. Criminality committed before the first psychiatric contact increased the age on first contact by 15 months, and if crimes were committed after the first contact but before the diagnosis of schizophrenia was made, the diagnosis was delayed another year.

The better known to the psychiatric hospital system patients were, the more likely the judicial system was to sentence them to psychiatric treatment or to withdraw the charges. Still a substantial part of the sentences passed, after the schizophrenia was diagnosed, were sentences to prison (8%) or suspended prison sentences (a further 8%). This is neither the intention of the Danish law nor that of the European prison rules, which Denmark has co-signed.

An earlier detection would be possible, if the threshold for requesting a forensic psychiatric evaluation of a presumed offender was lowered. Additionally, some sort of filter in the judicial system could be established (e.g. a self-rating questionnaire followed by a psychiatric evaluation for those suspected to have a mental illness). The latter would entail the development of a questionnaire and an evaluation of the advantages, drawbacks and possibilities of a regular screening.

In a cross-sectional study, studying 477 patients from the Danish National Schizophrenia Project cohort, the association between psychopathology and a criminal career before index admission was studied. The aim was to determine who was in need of crime preventive intervention.

Previous offending was associated with lower premorbid intellectual functioning, higher premorbid psychosocial functioning, and an overweight of positive symptomatology (e.g. delusions or hallucinations).