Skip to main content
SpringerLink
Log in

Cognitive and clinical characteristics of offenders and non-offenders diagnosed with schizophrenia spectrum disorders: results of the Recoviwel observational study

  • Original Paper
  • Published:
European Archives of Psychiatry and Clinical Neuroscience Aims and scope Submit manuscript

Abstract

The association between schizophrenia spectrum disorders (SSD) and violent behavior is complex and requires further research. The cognitive correlates of violent behavior, in particular, remain to be further investigated. Aims of the present study were to comprehensively assess the cognitive and clinical profile of SSD violent offenders and evaluate individual predictors of violent behavior. Fifty inmates convicted for violent crimes in a forensic psychiatry setting and diagnosed with SSD were compared to fifty non-offender patients matched for age, gender, education, and diagnosis. Offender and non-offender participants were compared based on socio-demographic, clinical, and cognitive variables using non-parametric testing to select potential predictors of violent behavior. Multivariate logistic regressions were then performed to identify individual predictors of violent behavior. Offender participants showed more school failures, higher prevalence of substance use, higher Clinical Global Impression Severity Scale (CGI-S) and Positive and Negative Syndrome Scale Excited Component (PANSS-EC) scores, worse working memory and better attention performance, higher Historical Clinical and Risk Management scale 20 (HCR-20) and Hare Psychopathy Checklist (PCL-R) scores in all subdomains and factors. School failures, higher PANSS-EC scores, worse working memory and processing speed, better attention performance, higher scores in HCR-20 Management subscale and the PCL-R “Callous” factor emerged as predictors of violent behavior. Better attentional performance was correlated with higher PCL-R “Callous” factor scores, worse cognitive performance in several domains with higher PCL-R “Unstable” factor scores. In conclusion, the present study highlights the importance of carefully assessing SSD patients with violent behavior in all clinical, cognitive, and behavioral aspects.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

The original contributions presented in the study are included in the article. Further inquiries are available upon reasonable request to the corresponding author.

References

  1. Caruso R, Antenora F, Riba M et al (2021) Aggressive behavior and psychiatric inpatients: a narrative review of the literature with a focus on the European experience. Curr Psychiatry Rep 23:29. https://doi.org/10.1007/s11920-021-01233-z

    Article  PubMed  PubMed Central  Google Scholar 

  2. Whiting D, Lichtenstein P, Fazel S (2021) Violence and mental disorders: a structured review of associations by individual diagnoses, risk factors, and risk assessment. Lancet Psychiatry 8:150–161. https://doi.org/10.1016/S2215-0366(20)30262-5

    Article  PubMed  Google Scholar 

  3. Brekke JS, Prindle C, Bae SW, Long JD (2001) Risks for individuals with schizophrenia who are living in the community. Psychiatr Serv Wash DC 52:1358–1366. https://doi.org/10.1176/appi.ps.52.10.1358

    Article  CAS  Google Scholar 

  4. Fazel S, Sariaslan A (2021) Victimization in people with severe mental health problems: the need to improve research quality, risk stratification and preventive measures. World Psychiatry 20:437–438. https://doi.org/10.1002/wps.20908

    Article  PubMed  PubMed Central  Google Scholar 

  5. Barlati S, Morena D, Nibbio G et al (2021) Internalized stigma among people with schizophrenia: Relationship with socio-demographic, clinical and medication-related features. Schizophr Res. https://doi.org/10.1016/j.schres.2021.06.007

    Article  PubMed  Google Scholar 

  6. Latalova K, Kamaradova D, Prasko J (2014) Violent victimization of adult patients with severe mental illness: a systematic review. Neuropsychiatr Dis Treat 10:1925–1939. https://doi.org/10.2147/NDT.S68321

    Article  PubMed  PubMed Central  Google Scholar 

  7. Maniglio R (2009) Severe mental illness and criminal victimization: a systematic review. Acta Psychiatr Scand 119:180–191. https://doi.org/10.1111/j.1600-0447.2008.01300.x

    Article  CAS  PubMed  Google Scholar 

  8. Rossa-Roccor V, Schmid P, Steinert T (2020) Victimization of people with severe mental illness outside and within the mental health care system: results on prevalence and risk factors from a multicenter study. Front Psychiatry 11:932. https://doi.org/10.3389/fpsyt.2020.563860

    Article  Google Scholar 

  9. Barlati S, Stefana A, Bartoli F et al (2019) Violence risk and mental disorders (VIORMED-2): a prospective multicenter study in Italy. PLoS ONE 14:e0214924. https://doi.org/10.1371/journal.pone.0214924

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Iozzino L, Ferrari C, Large M et al (2015) Prevalence and risk factors of violence by psychiatric acute inpatients: a systematic review and meta-analysis. PLoS ONE 10:e0128536. https://doi.org/10.1371/journal.pone.0128536

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Sariaslan A, Arseneault L, Larsson H et al (2020) Risk of subjection to violence and perpetration of violence in persons with psychiatric disorders in Sweden. JAMA Psychiat 77:359–367. https://doi.org/10.1001/jamapsychiatry.2019.4275

    Article  Google Scholar 

  12. Fazel S, Gulati G, Linsell L et al (2009) Schizophrenia and violence: systematic review and meta-analysis. PLoS Med 6:e1000120. https://doi.org/10.1371/journal.pmed.1000120

    Article  PubMed  PubMed Central  Google Scholar 

  13. Stevens H, Laursen TM, Mortensen PB et al (2015) Post-illness-onset risk of offending across the full spectrum of psychiatric disorders. Psychol Med 45:2447–2457. https://doi.org/10.1017/S0033291715000458

    Article  CAS  PubMed  Google Scholar 

  14. Duke AA, Smith KMZ, Oberleitner LMS et al (2018) Alcohol, drugs, and violence: a meta-meta-analysis. Psychol Violence 8:238–249. https://doi.org/10.1037/vio0000106

    Article  Google Scholar 

  15. Van Dorn R, Volavka J, Johnson N (2012) Mental disorder and violence: is there a relationship beyond substance use? Soc Psychiatry Psychiatr Epidemiol 47:487–503. https://doi.org/10.1007/s00127-011-0356-x

    Article  PubMed  Google Scholar 

  16. Fazel S, Smith EN, Chang Z, Geddes JR (2018) Risk factors for interpersonal violence: an umbrella review of meta-analyses. Br J Psychiatry J Ment Sci 213:609–614. https://doi.org/10.1192/bjp.2018.145

    Article  Google Scholar 

  17. Lamsma J, Cahn W, Fazel S, GROUP and NEDEN investigators (2020) Use of illicit substances and violent behaviour in psychotic disorders: two nationwide case-control studies and meta-analyses. Psychol Med 50:2028–2033. https://doi.org/10.1017/S0033291719002125

    Article  PubMed  Google Scholar 

  18. Bo S, Abu-Akel A, Kongerslev M et al (2011) Risk factors for violence among patients with schizophrenia. Clin Psychol Rev 31:711–726. https://doi.org/10.1016/j.cpr.2011.03.002

    Article  PubMed  Google Scholar 

  19. Fazel S, Wolf A, Larsson H et al (2017) Identification of low risk of violent crime in severe mental illness with a clinical prediction tool (Oxford Mental Illness and Violence tool [OxMIV]): a derivation and validation study. Lancet Psychiatry 4:461–468. https://doi.org/10.1016/S2215-0366(17)30109-8

    Article  PubMed  PubMed Central  Google Scholar 

  20. Fleischman A, Werbeloff N, Yoffe R et al (2014) Schizophrenia and violent crime: a population-based study. Psychol Med 44:3051–3057. https://doi.org/10.1017/S0033291714000695

    Article  CAS  PubMed  Google Scholar 

  21. Jeyagurunathan A, Lau JH, Abdin E et al (2022) Aggression amongst outpatients with schizophrenia and related psychoses in a tertiary mental health institution. Front Psychiatry. https://doi.org/10.3389/fpsyt.2021.777388

    Article  PubMed  PubMed Central  Google Scholar 

  22. Witt K, van Dorn R, Fazel S (2013) Risk factors for violence in psychosis: systematic review and meta-regression analysis of 110 studies. PLoS ONE 8:e55942. https://doi.org/10.1371/journal.pone.0055942

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Galderisi S, Rossi A, Rocca P et al (2014) The influence of illness-related variables, personal resources and context-related factors on real-life functioning of people with schizophrenia. World Psychiatry 13:275–287. https://doi.org/10.1002/wps.20167

    Article  PubMed  PubMed Central  Google Scholar 

  24. Green MF, Horan WP, Lee J (2019) Nonsocial and social cognition in schizophrenia: current evidence and future directions. World Psychiatry 18:146–161. https://doi.org/10.1002/wps.20624

    Article  PubMed  PubMed Central  Google Scholar 

  25. Harvey PD, Strassnig M (2012) Predicting the severity of everyday functional disability in people with schizophrenia: cognitive deficits, functional capacity, symptoms, and health status. World Psychiatry 11:73–79. https://doi.org/10.1016/j.wpsyc.2012.05.004

    Article  PubMed  PubMed Central  Google Scholar 

  26. Vita A, Gaebel W, Mucci A et al (2022) EPA Guidance on treatment of cognitive impairment in schizophrenia. Eur Psychiatry. https://doi.org/10.1192/j.eurpsy.2022.2315

    Article  PubMed  PubMed Central  Google Scholar 

  27. Reinharth J, Reynolds G, Dill C, Serper M (2014) Cognitive predictors of violence in schizophrenia: a meta-analytic review. Schizophr Res Cogn 1:101–111. https://doi.org/10.1016/j.scog.2014.06.001

    Article  Google Scholar 

  28. Ahmed AO, Richardson J, Buckner A et al (2018) Do cognitive deficits predict negative emotionality and aggression in schizophrenia? Psychiatry Res 259:350–357. https://doi.org/10.1016/j.psychres.2017.11.003

    Article  PubMed  Google Scholar 

  29. Rund BR (2018) A review of factors associated with severe violence in schizophrenia. Nord J Psychiatry 72:561–571. https://doi.org/10.1080/08039488.2018.1497199

    Article  PubMed  Google Scholar 

  30. Bulgari V, Iozzino L, Ferrari C et al (2017) Clinical and neuropsychological features of violence in schizophrenia: a prospective cohort study. Schizophr Res 181:124–130. https://doi.org/10.1016/j.schres.2016.10.016

    Article  PubMed  Google Scholar 

  31. Keefe RSE, Harvey PD (2012) Cognitive impairment in schizophrenia. Handb Exp Pharmacol. https://doi.org/10.1007/978-3-642-25758-2_2

    Article  PubMed  Google Scholar 

  32. Reitan RM (1958) Validity of the trail making test as an indicator of organic brain damage. Percept Mot Skills 8:271–276. https://doi.org/10.2466/pms.1958.8.3.271

    Article  Google Scholar 

  33. Stroop JR (1938) Factors affecting speed in serial verbal reactions. Psychol Monogr 50:38–48. https://doi.org/10.1037/h0093516

    Article  Google Scholar 

  34. Fusar-Poli P, Deste G, Smieskova R et al (2012) Cognitive functioning in prodromal psychosis: a meta-analysis. Arch Gen Psychiatry 69:562–571. https://doi.org/10.1001/archgenpsychiatry.2011.1592

    Article  PubMed  Google Scholar 

  35. Vita A, Barlati S, Ceraso A et al (2021) Effectiveness, core elements, and moderators of response of cognitive remediation for schizophrenia: a systematic review and meta-analysis of randomized clinical trials. JAMA Psychiat 78:848–858. https://doi.org/10.1001/jamapsychiatry.2021.0620

    Article  Google Scholar 

  36. Kerr SL, Neale JM (1993) Emotion perception in schizophrenia: specific deficit or further evidence of generalized poor performance? J Abnorm Psychol 102:312–318. https://doi.org/10.1037//0021-843x.102.2.312

    Article  CAS  PubMed  Google Scholar 

  37. Guy W (1976) ECDEU assessment manual for psychopharmacology. U.S. Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute of Mental Health, Psychopharmacology Research Branch, Division of Extramural Research Programs

  38. Kay SR, Fiszbein A, Opler LA (1987) The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophr Bull 13:261–276. https://doi.org/10.1093/schbul/13.2.261

    Article  CAS  PubMed  Google Scholar 

  39. Montoya A, Valladares A, Lizán L et al (2011) Validation of the Excited Component of the Positive and Negative Syndrome Scale (PANSS-EC) in a naturalistic sample of 278 patients with acute psychosis and agitation in a psychiatric emergency room. Health Qual Life Outcomes 9:18. https://doi.org/10.1186/1477-7525-9-18

    Article  PubMed  PubMed Central  Google Scholar 

  40. Patton JH, Stanford MS, Barratt ES (1995) Factor structure of the Barratt impulsiveness scale. J Clin Psychol 51:768–774. https://doi.org/10.1002/1097-4679(199511)51:6%3c768::aid-jclp2270510607%3e3.0.co;2-1

    Article  CAS  PubMed  Google Scholar 

  41. Bechara A, Damasio AR, Damasio H, Anderson SW (1994) Insensitivity to future consequences following damage to human prefrontal cortex. Cognition 50:7–15. https://doi.org/10.1016/0010-0277(94)90018-3

    Article  CAS  PubMed  Google Scholar 

  42. Kay SR, Wolkenfeld F, Murrill LM (1988) Profiles of aggression among psychiatric patients: I. Nature and prevalence. J Nerv Ment Dis 176:539–546. https://doi.org/10.1097/00005053-198809000-00007

    Article  CAS  PubMed  Google Scholar 

  43. Douglas KS, Webster CD (1999) The HCR-20 violence risk assessment scheme: concurrent validity in a sample of incarcerated offenders. Crim Justice Behav 26:3–19. https://doi.org/10.1177/0093854899026001001

    Article  Google Scholar 

  44. Hare RD (2003) The psychopathy checklist—revised manual. Tor Ont Can MHS

  45. Hare RD (2020) The PCL-R assessment of psychopathy. The Wiley International handbook on psychopathic disorders and the law. John Wiley & Sons Ltd, pp 63–106

    Chapter  Google Scholar 

  46. Heinze G, Wallisch C, Dunkler D (2018) Variable selection – a review and recommendations for the practicing statistician. Biom J Biom Z 60:431–449. https://doi.org/10.1002/bimj.201700067

    Article  Google Scholar 

  47. Midi H, Sarkar SK, Rana S (2010) Collinearity diagnostics of binary logistic regression model. J Interdiscip Math 13:253–267. https://doi.org/10.1080/09720502.2010.10700699

    Article  Google Scholar 

  48. Peduzzi P, Concato J, Kemper E et al (1996) A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 49:1373–1379. https://doi.org/10.1016/s0895-4356(96)00236-3

    Article  CAS  PubMed  Google Scholar 

  49. Vittinghoff E, McCulloch CE (2007) Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol 165:710–718. https://doi.org/10.1093/aje/kwk052

    Article  PubMed  Google Scholar 

  50. Erskine HE, Norman RE, Ferrari AJ et al (2016) Long-term outcomes of attention-deficit/hyperactivity disorder and conduct disorder: a systematic review and meta-analysis. J Am Acad Child Adolesc Psychiatry 55:841–850. https://doi.org/10.1016/j.jaac.2016.06.016

    Article  PubMed  Google Scholar 

  51. Valsecchi P, Nibbio G, Rosa J et al (2021) Adult ADHD: prevalence and clinical correlates in a sample of Italian psychiatric outpatients. J Atten Disord 25:530–539. https://doi.org/10.1177/1087054718819824

    Article  PubMed  Google Scholar 

  52. Slotboom J, Hoppenbrouwers SS, Bouman YHA et al (2017) Visual attention in violent offenders: susceptibility to distraction. Psychiatry Res 251:281–286. https://doi.org/10.1016/j.psychres.2017.02.031

    Article  PubMed  Google Scholar 

  53. Maj M, van Os J, De Hert M et al (2021) The clinical characterization of the patient with primary psychosis aimed at personalization of management. World Psychiatry 20:4–33. https://doi.org/10.1002/wps.20809

    Article  PubMed  PubMed Central  Google Scholar 

  54. Morin L, Franck N (2017) Rehabilitation interventions to promote recovery from schizophrenia: a systematic review. Front Psychiatry. https://doi.org/10.3389/fpsyt.2017.00100

    Article  PubMed  PubMed Central  Google Scholar 

  55. Nibbio G, Barlati S, Cacciani P et al (2020) Evidence-based integrated intervention in patients with schizophrenia: a pilot study of feasibility and effectiveness in a real-world rehabilitation setting. Int J Environ Res Public Health 17:E3352. https://doi.org/10.3390/ijerph17103352

    Article  CAS  Google Scholar 

  56. Vita A, Barlati S, Ceraso A et al (2022) Acceptability of cognitive remediation for schizophrenia: a systematic review and meta-analysis of randomized controlled trials. Psychol Med. https://doi.org/10.1017/S0033291722000319

    Article  PubMed  PubMed Central  Google Scholar 

  57. Firth J, Stubbs B, Rosenbaum S et al (2017) Aerobic exercise improves cognitive functioning in people with schizophrenia: a systematic review and meta-analysis. Schizophr Bull 43:546–556. https://doi.org/10.1093/schbul/sbw115

    Article  PubMed  Google Scholar 

  58. Stubbs B, Vancampfort D, Hallgren M et al (2018) EPA guidance on physical activity as a treatment for severe mental illness: a meta-review of the evidence and Position Statement from the European Psychiatric Association (EPA), supported by the International Organization of Physical Therapists in Mental Health (IOPTMH). Eur Psychiatry J Assoc Eur Psychiatr 54:124–144. https://doi.org/10.1016/j.eurpsy.2018.07.004

    Article  Google Scholar 

  59. Vita A, De Peri L, Barlati S et al (2011) Psychopathologic, neuropsychological and functional outcome measures during cognitive rehabilitation in schizophrenia: A prospective controlled study in a real-world setting. Eur Psychiatry 26:276–283. https://doi.org/10.1016/j.eurpsy.2010.03.008

    Article  CAS  PubMed  Google Scholar 

  60. Ahmed AO, Hunter KM, Goodrum NM et al (2015) A randomized study of cognitive remediation for forensic and mental health patients with schizophrenia. J Psychiatr Res 68:8–18. https://doi.org/10.1016/j.jpsychires.2015.05.013

    Article  PubMed  Google Scholar 

  61. O’Reilly K, Donohoe G, O’Sullivan D et al (2019) A randomized controlled trial of cognitive remediation for a national cohort of forensic patients with schizophrenia or schizoaffective disorder. BMC Psychiatry 19:27. https://doi.org/10.1186/s12888-019-2018-6

    Article  PubMed  PubMed Central  Google Scholar 

  62. Thomas ML, Bismark AW, Joshi YB et al (2018) Targeted cognitive training improves auditory and verbal outcomes among treatment refractory schizophrenia patients mandated to residential care. Schizophr Res 202:378–384. https://doi.org/10.1016/j.schres.2018.07.025

    Article  PubMed  PubMed Central  Google Scholar 

  63. Tengström A, Hodgins S, Kullgren G (2001) Men with schizophrenia who behave violently: the usefulness of an early- versus late-start offender typology. Schizophr Bull 27:205–218. https://doi.org/10.1093/oxfordjournals.schbul.a006867

    Article  PubMed  Google Scholar 

  64. Galderisi S, Mucci A, Dollfus S et al (2021) EPA guidance on assessment of negative symptoms in schizophrenia. Eur Psychiatry 64:e23. https://doi.org/10.1192/j.eurpsy.2021.11

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

All authors who contributed to this paper are listed as authors. No professional medical writer was involved in any portion of the preparation of the manuscript.

Funding

The authors received no specific funding for this work.

Author information

Authors and Affiliations

  1. Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy

    Stefano Barlati, Gabriele Nibbio, Irene Calzavara-Pinton, Nicola Necchini, Giacomo Deste & Antonio Vita

  2. Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy

    Stefano Barlati, Valentina Stanga, Giulia Giovannoli, Jacopo Lisoni, Giacomo Deste & Antonio Vita

  3. Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy

    Gabriele Nibbio

Authors
  1. Stefano Barlati
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gabriele Nibbio
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Valentina Stanga
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giulia Giovannoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Irene Calzavara-Pinton
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nicola Necchini
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jacopo Lisoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Giacomo Deste
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Antonio Vita
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stefano Barlati.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest in the design, execution, interpretation, or writing of the study.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Barlati, S., Nibbio, G., Stanga, V. et al. Cognitive and clinical characteristics of offenders and non-offenders diagnosed with schizophrenia spectrum disorders: results of the Recoviwel observational study. Eur Arch Psychiatry Clin Neurosci 273, 1307–1316 (2023). https://doi.org/10.1007/s00406-022-01510-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00406-022-01510-9

Keywords

Search

Navigation