Forensic Flashcards
What is the best predictor of future violence?
History of past violence
What are some predictors of future violence?
- substance misuse
- previous expression of intent to harm others
- previous dangerous impulsive acts
- denial of previous established dangerous acts
- explosive or impulsive personality traits
- active symptoms of schizophrenia or mania
What is most likely to be associated with juvenile delinquency (law breaking activity in 10-20 year olds)?
parent criminality
Which factors are asscoiated with juvenile delinquency (law breaking activity in 10-20 year olds)?
- parent criminality
- low IQ
- Conduct disorder
- large family size
What % of children will have stopped offending by aged 19?
50%
What’s the prevalence of violence in outpatients with Schizophrenia?
5%
What’s the most common type of aggression in people with Schizophrenia?
verbal
Criminal behaviour in patients with Schizophrenia
- it increases with substace misuse
- Patients with schizophrenia usually assault a known person rather than a stranger.
- Violence is a common precipitant prior to the first admission to psychiatric ward
- Violence in patients with schizophrenia is not always a result of psychosis
-THEY DO NOT HAVE HIGHER RATES OF OFFENDING THAN THE GENERAL POPULATION
Criminal behaviour in patients with epilepsy
- There is an approximately twofold increase in the prevalence of epilepsy in prisoners compared with the general population
- the rate and type of offending by those with epilepsy are similar to the general population
- low intelligence is associated with violence in people with epilepsies
OFFENDING IS RARELY DURING THE ICTAL PHASE
Which offence is most associated with people with Asperger syndrome?
Property destruction and Fire setting
Which methods can be used to treat sex offenders?
-Cyproterone
-medroxyprogesterone
(both are contraindicated in liver disease and VTE)
-SSRIs where there are ruminations
-CBT
Which tools are useful for predicting sex offence recidivism?
- Rapid Risk Assessment for Sex Offence Recidivism (RRASOR)
- Sex Offender Risk Appraisal Guide (SORAG)
- Sexual Violence Risk-20 (SVR-20)
- Structured Anchored Clinical Judgement (SACJ)
What is the most important risk factor for violence both in general and mentally disordered populations?
Substance misuse
What is Pseudologia fantastica?
Pseudologia fantastica is one of the more extreme forms of pathological lying. This is a matrix of facts and fiction, mixed together in a way that makes the reality and fantasy almost indistinguishable. It is usually seen in forensic practice.
The duty to warn the 3rd parties in case of imminent danger is illustrated by which case?
Tarasoff’s case
Victims of womens’ violent acts are more likely to be?
Family members
What are the The Fitness to Plead / Pritchard Criteria?
Relates to the mental state of the defendant at the time of the trial. They include:
- ability to understand charges
- ability to follow proceedings
- ability to instruct counse
- ability to understand the difference between pleading guilty and not guilty
- ability to challenge a juror
What does not interfere with one’s fitness to plead?
Amnesia for the offense
What is Ganser’s syndrome?
Ganser’s syndrome is a rare dissociative disorder - often seen in people awaiting trial
What are the core features of Ganser’s syndrome?
approximate answers, clouding of consciousness, somatic conversion symptoms and hallucinations (visua pseudohallucinations)
Which of the following types of stalker is most likely to commit a homicide?
Predatory stalker
In females which age group is associated with the highest risk of committing a homicide?
30-39
Which mental illness most closely linked with murder-suicide?
Depression, especially in men
Which diagnosis is most commonly made in stalkers?
Antisocial PD
Which personality traits are more often seen in elderly sexual offenders than non offending older individuals?
Schizoid
Proportion of all homicides commited by individuals with schizophrenia?
5% (annual risk of a patient with schizophrenia committing homicide = 1 in 10,000)
Victims of female homicide perpetrators with psychosis often belong to age group?
<16
Most offenders with charge of exhibitionism belong to age group?
15-25 years
% of members of Royal College Psychiatrists who experience stalking?
22%
Proportion of those discharged from medium secure units that are convicted for violent offence within 2 years?
6%
Paedophilia
Offender usually male
50-70% have another paraphilia
1/3 adolescents
Girls twice as likely to be victims
Which group of sexual offenders are more likely to be married?
Exhibitionists
Annual risk of a HCP to be stalked?
10%
RR of psychosis in prisons compared to general population?
20
DSM requires evidence of antisocial behaviour pattern by which age in order to diagnose ASPD?
15
No of infanticides reported per year
20 (all infant homicides = 30-45 per year)
Prevalence of psychotic illness in patients with epilepsy?
3-7%
Prevalence of epilepsy in patients with schizophreniform psychosis?
0.4 - 1%
Prevalence of psychosis in prison population?
50 per 1000
5%
% of people convicted of indecent exposure have no prev record of sexual offences?
20%
Low rates of recidivism in a sexual offence are indicated by which features?
Incestual sex offence against a child
Offending behaviour of adults with LD
Adults with borderline and mild LD account for most of the offending behaviour
What are the most common mental disorders found in sex offenders?
Personality disorder
Paraphilias
Alcohol and substance misuse
PSYCHOTIC DISORDERS ARE NOT COMMON
Prevalence of ASPD?
0.6%
Is exhibitionism included in ICD10/DSM4?
It is included in both the DSM-IV and ICD-10 classification systems
What % of female prisoners have borderline personality disorder?
20% of female prisoners have borderline personality disorder.
According to English and Welsh law, at what age does a person become responsible for their actions and therefore liable to prosecution?
10 (8 in Scotland)
Which mental health problems is associated with the highest rate of homicide?
Substance misuse (contributes to 61% of homicides)
Are people with mental illness or intellectual disability more likely to be victims of violence or to be perpetrators?
People with mental illness or intellectual disability are also more likely to be victims of violence than they are to be perpetrators.
What is the peak age for male offenders in the UK?
17-18
What is the peak age for female offenders in the UK?
14
Conviction male: female
In the UK convicted males outnumber females by 5 to 1.
What is involuntary manslaughter?
the defendant never meant to kill the victim but they did by action of their behaviour (e.g. medical manslaughter).
What is voluntary manslaughter?
the defendant may have intended to kill the victim but there was a good reason (e.g. they thought they were going to be killed).
Which homicide plea can result in acquittal?
Self defence
Which punishments that can be given to children under 10 who break the law?
Local Child Curfew
The police can ban children from being in a public place between 9pm and 6am, unless accompanied by an adult. This can last for up to 90 days.
If a child breaks their curfew, they can be given a Child Safety Order.
Child Safety Order
If a child has committed an offence or broken a Local Child Curfew, they can be placed under the supervision of a youth offending team. This is called a Child Safety Order.
This lasts for up to 3 months, but in some cases it can last for up to 12 months. If a child doesn’t stick to the rules of an order, the court can consider if the child should be taken into care.
How are children who commit crimes between the ages of 10-17 treated differently from adults?
dealt with by youth courts
given different sentences
sent to special secure centres for young people, not adult prisons
In order to be found not guilty by reason of insanity a person must satisfy which rules?
McNaughten rules:
- Did not understand the quality or nature of the act
- Did not know what they were doing was wrong
- If under a delusion that prevents the true appreciation of the nature and quality of his act, he is under the same degree of responsibility as if the facts were how he imagined them to be. For example, if acted in self-defence believing life in danger then would be treated as if acting in self-defence
What is Automatism? What are the two types?
Automatism
Automatism is a defence used when the act is believed to have occurred unconsciously/involuntarily. It comes in two forms:-
Sane automatism - where the act occurs from an external cause such as a head injury.
Insane automatism - where the act occurs from an internal cause such as epilepsy, night walking etc
What are Indictable offences?
These are considered more serious and are tried in the Crown Court. Examples of Indictable offences include:
Rape or aggravated sexual assault
Murder or attempted murder
Piracy
Treason
What’s the difference between criminals and civil law?
Criminal law mostly involves the rules laid down by the state for citizens, while civil law governs the relationships and transactions between citizens.
Which court do all criminal cases go?
All criminal cases will first go to the Magistrates’ Court.
What the three main categories that criminal offences are divided into?
Criminal offences are divided into three main categories:
Summary offences - These are the least serious offences and are tried in the Magistrates’ Court.
Summary offences involve a maximum penalty of 6 months imprisonment and/or a fine of up to £5000
Triable either way offences - These can be regarded as the middle range of crimes and include a wide variety of crimes e.g. theft, assault causing actual bodily harm. These can be tried in either the Magistrates’ Court or Crown Court.
Indictable Offences - These are the more serious crimes and include murder, manslaughter and rape. All indictable offences must be tried at the Crown Court, but the first hearing is dealt with at the Magistrates’ Court. The magistrate will decide if the defendant should be given bail. The case is then transferred to the Crown Court.
What % of cases are completed at Magistrates’ courts?
95%
What % of stalking victims are assaulted?
10-33%
Which setting is persistent stalking reportedly high in?
Persistence is reportedly high in workplace stalking and among professionals pursued by ex-patients and clients.
Which proportion of stalkers re offend?
Almost half re-offend, with most returning to stalking within 12 months
What’s the risk of being stalked by a patient over a year? And over a career?
The risk of being stalked by a patient or a patients relative is between 5% and 10% in a year, and around 20% over the course of a career
Do most stalkers fit criteria for compulsory mental health treatment?
No
What’s the HCR 20?
Historical-Clinical-Risk Management-20 (HCR-20)
Used for assessing violence in inpatients and discharged patients in the community
What’s the RSVP?
Risk of Sexual Violence Protocol (RSVP)
for assessing risk of sexual violence
What’s the SARA?
Spousal Assault Risk Assessment Guide (SARA)
It can be used to help gauge risk of future violence in men arrested for spousal assault
What’s the SAM?
Stalking Assessment and Management (SAM)
Structured professional judgement tool for assessing risk of stalking behaviors
What’s the SVR20?
Sexual Violence Risk-20 (SVR-20)
Assesses risk of committing sexual violence and for targeting plans to manage that risk
What’s the RM 2000?
Risk Matrix 2000 (RM2000
consists of 3 scales
- a prediction scale for sexual offending
- a prediction scale for non-sexual violence engaged in by sex offenders
- a combination of the first two scales and predicts sexual or other violence
What’s Static-99?
Static-99
actuarial assessment instrument for use with adult male sexual offenders who are at least 18 year of age at time of release to the community
What’s VRAG?
Violence Risk Appraisal Guide (VRAG)
predicts risk of violence within a specific time frame following release in violent, mentally disordered offenders
The Hare PCL-R (Psychopathy Checklist -Revised) score is incorporated into the VRAG calculations of risk
Separation from either biological parent by age 16 (Except for death of parent)
Elementary school maladjustment score
Alcohol problems
Never married
Criminal history score for non-violent offences
Failure on prior conditional release
Age at index offence
Most serious victim injury (from the index offence)
Female victim in the index offence
Meets DSM-III criteria for any personality disorder
Meets DSM-III criteria for schizophrenia
What’s SORAG?
Sex Offender Risk Appraisal Guide (SORAG)
modification of the VRAG and is used to assess the risk of violent and sexual recidivism of previously convicted sex offenders within a specific period of release.
incorporates the PCL-R scores
What’s the PCL-R?
Hare’s Psychopathy Checklist (PCL-R)
used to assess likely future recidivism and violent offending.
What’s RRASOR?
Rapid Risk Assessment for Sex Offence Recidivism (RRASOR)
Prior sexual arrests
Age
Ever targeted male victims
Whether any victims unrelated to the offender
Which term refers to the act of killing one’s husband?
Mariticide
What is Filicide?
refers to the act of a parent killing their child (in England and Wales anyone under the age of 18)
What is Infanticide?
the killing of an infant (by a MOTHER) from birth to 12 months
Only mothers can be convicted of infanticide as it is a special charge relating to the killing of a child under 12 months of age by their mother who at the time was mentally disturbed as a direct result of childbirth or lactation (i.e. it is biologically related to the process of having a child).
What is Neonaticide?
the killing of an infant (by a parent) within the first 24 hours of life
What is matricide?
is the act of killing one’s mother
What is patricide?
refers to the killing of one’s father
What is fraticide?
refers to the killing of one’s brother
What’s the term for killing of one’s wife?
Uxoricide
What is sororicide?
the act of killing one’s own sister
What most relationship of the victim in a homicide committed by a patient of mental health services?
Acquaintance
What is the most common method of homicide?
The most common method of homicide was the use of a sharp instrument (40%).
What % of people convicted of homicide in England are considered to have an abnormal mental state at the time of the offence?
Around 10% of people convicted of homicide in England are considered to have an abnormal mental state at the time of the offence (2/3 = psychosis).
Partial defences to murder include:
diminished responsibility (changes murder to manslaughter if absence of mens rea is proved)
loss of control
killing pursuant to a suicide pact
What’s the main use of the DUNDRUM toolkit?
Estimating the level of security required for a forensic patient
Dangerousness, Understanding, Recovery, Urgency, Manual) toolkit is a set of structured professional judgement instruments
used to distinguished between patients who required admission to different levels of therapeutic security and distinguished the urgency of need amongst patients.
DUNDRUM-1 triage security
DUNDRUM-2 Triage Urgency
DUNDRUM-3 Programme Completion
DUNDRUM-4 Recovery Items
Lifetime risk of suicide in dependent drinkers?
10-15%
% of old age patients that see their GP on the same day of their suicide?
20%
40-50% within one week
70% within one month
Risk of completed suicide in people with history of DSH is?
10%
Most reliable risk factor for competed suicide?
Previous suicide attempts
Male to female ratio of suicide age 15-24?
4:1
Complete rate of suicide in the age range of 10-14?
1-2 per 100 000
What percentage of patients contacted the general practitioner within 1 month before attempting suicide?
60%
The highest risk factor for suicide in a prisoner is?
History of substance misuse
Approximately what percentage of patients eventually kill themselves in 1 year following deliberate self-harm (DSH)?
1%
When in the course of their illness do people with Schizophrenia tend to commit suicide?
Early
Whats % of patients with schizophrenia commit suicide?
10%
What is the most common cause of attempted suicide in 16 year olds?
Relationship difficulties with parents
Which mental health condition is most commonly associated with suicide?
Depression
What are the risk factors for suicide?
- Male gender
- Unemployment
- Concurrent mental disorders
- Previous suicide attempt
- Substance misuse
- Low socio-economic status
- high social class
- divorce
- poor social support
What % of people who commit suicide have a diagnosable mental disorder?
About 90%
In the UK, suicide tends to be most common in which age groups?
40-44
Average suicide rate in the general population?
The report recorded an average suicide rate of approximately 1 per 10,000 in the general population
Most common personality disorder in prisoners?
Most common personality disorder in prisoners is antisocial.
Which factors have been shown to increase the risk of suicide in prisoners?
Having a mental illness
Being in a single cell
Being married (note this is in contrast to the general population where this is a protective factor)
Being male
Having a history of substance misuse
Having a history of previous self harm or attempted suicide
Recent suicidal ideation
Being on remand
According to data from England and Wales, what is the most commonly reported victim-offender relationship among victims of the most serious sexual offence types (rape and penetration)?
Partner
What are the most common diagnoses seen in offences of arson?
Alcohol use disorder, psychoses, LD and PD
Historical factors on HCR-20
H1 Previous violence H2 Young age at first violent incident H3 Relationship instability H4 Employment problems H5 Substance use problems H6 Major mental illness H7 Psychopathy H8 Early maladjustment H9 Personality disorder H10 Prior supervision failure
Clinical factors on HCR-20
C1 Lack of insight C2 Negative attitudes C3 Active symptoms of Major Mental Illness C4 Impulsivity C5 Unresponsive to treatment
Risk management factors on HCR-20
R1 Plans lack feasibility R2 Exposure to destabilizers R3 Lack of personal support R4 Noncompliance with remediation attempts R5 Stress
According to data from England and Wales, what percent of victims of the most serious sexual offences in the previous year knew the perpetrator?
90%
What % of females report being a victim of the most serious offences of rape or sexual assault by penetration in the previous 12 months?
0.5%
What are the inpatient levels of obs?
General observation. This is the minimum acceptable level. Whilst on this level the location of all service users must be known. At least once a shift a nurse should set aside dedicated time to assess the patient.
Intermittent observation. Whilst on this level the service user’s location should be checked every 15 to 30 minutes.
Within eyesight observationWhilst on this level the service user should be kept within eyesight and accessible at all times, by day and by night
Within arms length observation. This is needed for service users at the highest levels of risk of harming themselves or others, who should be supervised in close proximity
According to data from England and Wales, approximately what percent of males report being a victim of the most serious offences of rape or sexual assault by penetration in the previous 12 months?
0.1
What are the Pritchard criteria?
Fitness to plead
Must be able to instruct his solicitor and counsel
Must understand the charge(s)
Must be able to decide whether to plead guilty or not
Must be able to follow court proceedings enough to make a proper defence
Must know they can challenge a juror
Must be able to give evidence in his or her own defence
Who form the majority of those unfit to plead?
The majority of those who are found unfit to plead suffer from schizophrenia or another enduring mental illness.
What happens if someone is unfit to plead?
they are dealt with by the use of the Criminal Procedures Act 1991. This involves the following:-
A trial of facts
Complete acquittal if the facts are not found
Flexible disposal by the judge if the facts are found. Except for murder where there is mandatory committal to hospital
What is the most common method of suicide used by patients of mental health services?
Hanging
In the case of R v Pritchard which covers issues on fitness to plead, of what crime was Pritchard accused?
Beastiality
Whose law states that a higher national homicide rate correlates with a lower national number of psychiatric hospital beds?
Penrose’s law
Which report led to the development of medium secure hospitals?
Butler report
Risk factors for violence in in-patient settings
Patient risk factors:
Being young
History of violence
Being compulsarily admitted
Co-morbid substance misuse
Being in the acute phase of the illness
Environmental risk factors:
Lack of structured activity
High use of temporary staff
Low levels of staff-patient interaction
Poor staffing levels
Poorly defined staffing roles
Unpredictable ward programmes
Lack of privacy
Overcrowding
Poor physical facilities
Availability of weapons
According to data from England and Wales, what is the commonest type of sexual offence?
Sexual assault accounting for 41% of the sexual offences reported
Altruistic homicide is most associated with which illness?
Depression
closest estimate of the male to female ratio of suicides in the UK?
3:1
What is Partialism?
Exclusive focus on one part of the body
What is Acrotomophilia?
Focus of sexual interest on People with amputations
What is Coprophilia?
Focus of sexual interest is faeces
What is a tool involving both a self-reported component and a semi-structured interview used to screen for personality disorders?
IPDE
What is SAPAS?
SAPAS (Standardised assessment of personality abbreviated scale)
Personality disorder Interview method
What is FFMRF
FFMRF (Five factor model rating form)
Self reported
Consists of 30 items
Rated 1-5 for each item
Based on symptoms rather than diagnoses
What is PDQ-R?
PDQ-R (Personality Diagnostic Questionnaire-Revised)
Self reported
100 true/ false questions
Takes 30 minutes to complete
Based on DSM-IV criteria
What is IPDS?
IPDS (Iowa Personality Disorder Screen)
Interview method
What is IIP-PD?
IIP-PD (IIP Personality Disorder Scales)
Self reported
Contains of 127 items
Items rated 0-4
What are the strongest predictors of sexual offense recidivism?
Variables related to sexual deviancy
such as deviant sexual preferences, prior sexual offenses, early onset of sexual offending and the diversity of sexual crimes.
The single strongest predictor was sexual interest in children as measured by phallometric assessment.
Risk factors for infanticide?
Being single (not married)
Young maternal age
Low level of education
Previous births
the commonest method of suicide in women in the UK?
Poisoning by overdose
According to data from England, how many times more likely is a mental health service user to commit suicide than a member of the general population?
10
What percentage of offenders are responsible for 50% of all reported crimes?
5%
Approximately what percentage of male prisoners meet diagnostic criteria for antisocial personality disorder?
50%
Approximately what percentage of female prisoners meet diagnostic criteria for antisocial personality disorder?
30%
Which item on the VRAG shows the strongest correlation with violent recidivism?
PCL-R score
Which report sought to tackle the over-representation of people with mental
health problems in prisons in England?
Bradley Report
- Proposed creation of a national network of Criminal Justice Mental Health teams to divert people towards support services from police stations, from courts and following release from prison
- called for a 14-day maximum wait for people who need to be transferred from prison to hospital for urgent mental health treatment
- called for the NHS to take on responsibility for providing health services in police stations
What percentage homicides in England and Wales are committed by people with a diagnosis of personality disorder?
9%
What fraction of violent crimes is committed by people with severe mental illness?
1 in 20
What % of those with schizophrenia convicted of homicide had never had contact with psychiatric services?
30% of those with schizophrenia convicted of homicide had never had contact with psychiatric services
What % of all serious fires are started deliberately?
Approximately 40% of all serious fires are started deliberately
*peak age for arson is 17 for men and 45 for women; 80% of those convicted are men. There is an increased incidence of arson among those with learning disabilities and those who suffer from alcohol dependence syndrome.
Approaches based on assessing risk at the group level are termed?
Actuarial
What proportion of people suffering with psychosis commit the act of homicide each year?
1 in 10 000
risk factors for juvenile delinquency?
Poverty
Large family size
Lower mean IQ
Unsatisfactory child rearing
Parental criminality
Troublesomeness at school
According to UK data from 1998 to 2006, what percentage of restricted patients were re-convicted within 2 years of being moved into the community?
7%
What is recommended by NICE for the treatment of antisocial personality disorder?
Group based cognitive interventions
SMR in ASPD
SMR (standardised mortality ratio) is estimated to be around 8.
The Gudjonsson Scale is most useful for assessing what?
Suggestibility
What is exhibitionism?
a recurrent or persistent tendency to expose the genitalia to strangers in public places, without inviting or intending closer contact.’
Exhibitionism is almost entirely limited to heterosexual males. Urges are usually ego-alien and tend to become more intense during periods of stress. The exhibitionist’s excitement is enhanced if the witness appears frightened. The act is usually associated with a degree of sexual excitement.
Which case highlights the role of the police in informing potential victims?
Osman
Which medications are not recommended (by NICE) for rapid tranquillisation?
Intramuscular diazepam
Intramuscular or oral chlorpromazine
Thioridazine
Intramuscular depot antipsychotics
Olanzapine or risperidone should not be used for the management of disturbed/violent behaviour in service users with dementia
What percentage of homicides in the UK are committed by people with a life time history of ‘mental disorder’?
30%
What percentage of prisoners in England and Wales aged 60 and over are estimated to have a diagnosis of personality disorder?
30%
Which PDs are most common in older prisoners?
Antisocial and avoidant personality disorders are thought to be the most common personality disorders in older prisoners (prevalence is approximately 8% for both).
How many non-fatal assaults occur each year?
1 million
How are non-fatal assaults classified?
Common
Aggravated
Battery
what percentage of women have been stalked in their lifetime?
50%
what percentage of victims of stalking have PTSD?
37-60%
What % of sex offenders have a mental health illness?
<10%
What percentage of paedophiles have another paraphilia?
50-70%
What drugs can be used in sex offenders?
Ciproterone (blocks testosterone receptors)
Midroxyprogesterone
Buspirone
What proportion of sex offenders reoffend after release from prison?
< 1 in 5
What percentage of sex offenders have no previous convictions?
75-80%
What proportion of female victims of DV tell somebody?
1/3 (less for male victims)
What is morbid jealousy?
Core belief that somebody’s partner is cheating on them (aka Othello syndrome)
What is De Clerambault syndrome?
A belief that some more successful or famous is in love with them (more common in women)
What is Ganser syndrome?
A hysterical dissociative disorder often seen in prisoners
- approximate answers
- clouding of consciousness
- disorientation
- pseudohallucination
What percentage of people with severe mental illness were victims of crime in the past year?
40%
How much more common is suicide in the prison population compared to the general population?
8x, most commonly hanging and within 6 months of the beginning of the sentence
What is culpable homicide?
Between manslaughter and homicide, death occurs as an unintended result of assault or negligence
Which Human Rights articles are most relevant to forensic practice
Article 2 (right to life) Article 3 (prohibition of torture and degrading treatment) Article 5 (persoanl liberty) Article (private and family life)
At what age does co offending become less common?
17
What is Gastaut-Geschwind syndrome?
a group of behavioral phenomena evident in some people with temporal lobe epilepsy
What are the five features of Gastaut-Geschwind syndrome?
hpergraphia, hyperreligiosity, atypical (usually reduced) sexuality, circumstantiality, and intensified mental life
Which personality traits in Gastaut-Geschwind syndrome are risk factors for offending?
Hypo-moralism
Aggression
Emotional lability
What is the most common offence in England and Wales?
Fraud
Under which order can a child be taken away from mother?
Emergency Protection Order Section 44 of Children’s Act
The prevalence of antisocial personality disorder in the prisons of UK is
50%
The MacArthur Competence Assessment Tool for Treatment (MacCat-T) includes assessment of:
understanding, appreciation, expressing a choice, and reasoning
Most prevalent diagnosis in fire-setting?
Alcohol dependence (NESARC study) High rates of ASPD
