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4. Forensic psychiatry > Relationship between crime and mental illness > Flashcards

Relationship between crime and mental illness Flashcards

1
Q

Rate of violence among people with mental illness than the general population

A

4-6x higher among people with mental illness

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2
Q

Factors which are higher risk factors for violence than mental illness

A

Personality disorder
Drug misuse
Alcohol misuse
Male sex
Age between 15-30
Socioeconomic deprivation
Past history of violence

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3
Q

Percentage of patients with schizophrenia violent in the 20 weeks following discharge from a psychiatric setting

A

9%

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4
Q

Percentage of patients with depression violent in the 20 weeks following discharge from a psychiatric setting

A

19%

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5
Q

Percentage of patients with bipolar disorder violent in the 20 weeks following discharge from a psychiatric setting

A

15%

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6
Q

Percentage of patients with substance misuse disorders violent in the 20 weeks following discharge from a psychiatric setting

A

29%

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7
Q

Percentage of patients with personality disorder violent in the 20 weeks following discharge from a psychiatric setting

A

25%

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8
Q

Percentage of patients with another psychotic disorder (not schizophrenia or bipolar) violent in the 20 weeks following discharge from a psychiatric setting

A

17.2%

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9
Q

Percentage of patients in the community with schizophrenia who have committed a violent act in the preceding 12 months

A

10%

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10
Q

Percentage of general population living in the community who have committed a violent act in the preceding 12 months

A

2%

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11
Q

Annual risk of a male patient with schizophrenia committing homicide

A

1:3000

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12
Q

Annual risk of a female patient with schizophrenia committing homicide

A

1:33000

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13
Q

Percentage of prison population with psychosis

A

3.7%

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14
Q

Percentage of prison population with major depression

A

10%

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15
Q

Percentage of prison population with personality disorder

A

65%

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16
Q

Percentage of prison population with organic mental disorder

A

1%

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17
Q

Percentage of homicides related to a mental disorder

A

34%

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18
Q

Description of Penrose’s law

A

There is an inverse relationship between rates of prison occupancy and rates of mental institution occupancy

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19
Q

Number of homicides annually committed by a mentally disordered offender

A

50

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20
Q

Percentage of offenders of homicide who have an abnormal mental state at the time of the offence

A

10%

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21
Q

Annual risk of a patient with schizophrenia committing homicide

A

1:10000

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22
Q

Annual risk of a person with schizophrenia being convicted of violence

A

1:150

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23
Q

Definition of filicide

A

A mother killing their own child

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24
Q

D’Orban’s six types of filicides

A

Battering mothers
Mentally ill mothers
Neonaticides
Retaliating women
Unwanted children
Mercy killings

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25
Q

Description of ‘battering mothers’ group of filicides

A

Impulsive killing due to a loss of temper

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26
Q

Description of ‘neonaticides’ group of filicides

A

Usually defined as killing of a child within 24 hours of life

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27
Q

Description of ‘retaliating women’ group of filicides

A

Mother’s aggression towards their partner is displaced onto the child

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28
Q

Description of ‘unwanted child’ group of filicides

A

Can be active killing or passive neglect; associated with unplanned pregnancies and socioeconomic deprivation

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29
Q

Description of ‘mercy killing’ group of filicides

A

Victim is genuinely suffering; no secondary gain for the mother

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30
Q

Most common mental illnesses associated with ‘mentally ill mothers’ group of filicides

A

Depression
Psychotic illness
Personality disorder

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31
Q

Definition of infanticide

A

Intentional killing of an infant (usually under 12 months old) by their mother

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32
Q

Definition of murder-suicide

A

Murder followed by suicide of the perpetrator within one week of the murder

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33
Q

Mental illness more common among murder-suicide perpetrators than homicide perpetrators

A

Depression

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34
Q

Two typical clinical presentations of murder-suicide perpetrators

A
  1. Middle aged man, recently separated from his partner, suffering from depression, access to firearms
  2. Older man, caregiver for his partner, recent onset of new illness in the man, depression, access to firearms
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35
Q

Definition of patricide

A

Killing of someone’s own parents (more often their father)

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36
Q

Definition of matricide

A

Killing of someone’s own mother

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37
Q

Percentage of homicides made up by patricide/(matricide)

A

2%

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38
Q

Typical demographic of a patricide perpetrator

A

Male
Aged 12-50
Motivated by revenge for sexual abuse or financial gain

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39
Q

Number of annual cases of non-fatal assault in England and Wales

A

1 million

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40
Q

Definition of common assault

A

Any act where someone intentionally or recklessly causes another person to suffer apprehend immediate unlawful violence

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41
Q

Definition of aggravated assault

A

An act where someone attempts or does cause serious bodily injury to another person purposefully or recklessly manifesting extreme indifference to human life; or with a deadly weapon

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42
Q

Definition of battery

A

An act where someone intentionally or recklessly applies unlawful force to the body of another person

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43
Q

Difference between assault and battery

A

Battery requires actual force; assault can be committed if someone indicated violence e.g. someone throws a punch that misses

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44
Q

Percentage of perpetrators of non fatal violence with schizophrenia

A

9%

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45
Q

Percentage of middle aged female shoplifters who are depressed

A

24-30%

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46
Q

Age at which shoplifting usually peaks

A

Adolescence

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47
Q

Percentage of shoplifters with a history consistent with kleptomania

A

1-2%

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48
Q

Percentage of people who set fires who do so intentionally

A

25%

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49
Q

Percentage of psychiatric patients with a history of fire setting behaviour

A

26%

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50
Q

Percentage of psychiatric patients who have previously set fires

A

16%

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51
Q

Association between IQ and fire setting

A

Low IQ gives a higher risk of fire setting

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52
Q

Typical demographics of an intentional fire setter

A

Young adult male
Relationship difficulties
Unmarried
Poorly educated
Isolated
Unemployed or unskilled labourer

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53
Q

Likelihood of males compared to females fire setting

A

Males 2.5x more likely

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54
Q

Groups of fire setters described by Faulk

A

Group 1 - fire setting as a means to an end e.g. fraud, revenge
Group 2 - fire setting for its own sake

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55
Q

Six criteria for pyromania according to DSM IV

A

Deliberate fire setting on multiple occasions
Emotional arousal and tension before fire setting
Fascination/attraction to fire
Pleasure or relief when setting fires
Exclusion of other causes
Fire setting not better accounted for by conduct disorder or personality disorder

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56
Q

Sex more associated with juvenile fire setting under the age of 10

A

Females

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57
Q

Reoffence rates of mentally disordered fire setters

A

11%

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58
Q

Reoffence rates of non mentally disordered fire setters

A

4%

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59
Q

Percentage of women who have been stalked in their lifetime

A

15%

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60
Q

Percentage of stalkers who are male

A

80-90%

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61
Q

Percentage of stalking victims who are women

A

80-90%

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62
Q

Typical demographics of a stalking victim

A

Woman
Reproductive age
Previous sexual relationship with the perpetrator

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63
Q

Typical demographics of a stalker

A

Male
Unemployed or underemployed
Well educated
Previous sexual relationship with their victim

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64
Q

Types of stalkers described by Mullen

A

Rejected - pursues ex-partners
Intimacy seekers - stalk someone they believe they love and loves them back
Incompetent suitors - inappropriately intrude, looking for a date
Resentful - look to get revenge for a real or imagined injury
Predatory - stalking forms part of other sexual offending

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65
Q

Psychiatric diagnoses most often seen in ex-partner stalkers

A

Borderline PD
Narcissistic PD
Histrionic PD
Antisocial PD

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66
Q

Psychiatric diagnoses most often seen in stranger stalkers

A

Delusional disorders, most commonly erotomania
Schizophrenia
Affective disorders
Organic psychosis

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67
Q

Percentage of stalking victims who develop PTSD

A

37-60%

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68
Q

Percentage of psychiatrists who consider themselves to have been stalked

A

22%

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69
Q

Percentage of psychiatrists who have experienced stalking behaviour meeting the legal definition of harassment

A

33%

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70
Q

Typical demographics of a stalker who has targeted a mental health professional

A

Male
Prior history of stalking
Under the care of the stalked clinician
Motivated by wanting more intimacy

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71
Q

Percentage of sexual offenders committing offences against children who are a relative of the child

A

13%

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72
Q

Percentage of sexual offenders committing offences against children who are known to the child but not a relative

A

68%

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73
Q

Percentage of child sexual abuse offenders who are male

A

90%

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74
Q

Percentage of child sexual abuse offenders who are adolescents

A

33%

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75
Q

Definition of incest in England/Wales vs. Scotland

A

Penetration must have occurred in both
In England/Wales step relatives are not included but in Scotland they are

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76
Q

Percentage of reported incest cases which involve children

A

30%

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77
Q

Percentage of perpetrators of indecent exposure who reoffend

A

20-30%

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78
Q

Definition of penile plethysmography

A

Determining sexual arousal by measuring changes in penile tumescence when images or stories of deviant sexual material are presented

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79
Q

Drug most commonly used to lower libido in the UK

A

Cyproterone

80
Q

Drug most commonly used to lower libido in the USA

A

Medroxyprogesterone

81
Q

Mental health condition which can be worsened by cyproterone

A

Depression

82
Q

Most common side effects of cyproterone

A

Deranged liver function
Osteoporosis
Gynaecomastia

83
Q

Largest study of non-incarcerated male sex offenders

A

Abel study

84
Q

Percentage of male sexual offenders in the Abel study who were married

A

30%

85
Q

Number of offenders in the Abel study who molested young boys compared to young girls

A

5x more molested young boys

86
Q

Percentage of convicted sexual offenders who have no previous sexual offence convictions

A

75-80%

87
Q

Percentage of sexual offenders who reoffend within 6 years of their release

A

9%

88
Q

Percentage of child sexual offenders who reoffend within 6 years of their release

A

13%

89
Q

Percentage of female victims of chronic domestic abuse who report to the police

A

20%

90
Q

Percentage of women who experience domestic abuse in their lifetime

A

25%

91
Q

Proportion of men who experience domestic abuse in their lifetime

A

1 in 6/1 in 7

92
Q

Percentage of male victims of domestic abuse who do not tell anyone

A

49%

93
Q

Percentage of female victims of domestic abuse who do not tell anyone

A

19%

94
Q

Typical presentation for people with schizophrenia who commit type 1 violence

A

Have organised delusions relating to the violence they commit
No history of conduct problems in earlier life
Nearly always attack a carer or an acquaintance

95
Q

Typical presentation for people with schizophrenia who commit type 2 violence

A

Have disorganised clinical syndromes
Have a history of conduct disorder
Have a history of substance abuse from a young age
Have a history of diverse offences
Commit both domestic and non-domestic offences

96
Q

Percentage of prison inmates who misuse substances

A

> 50%

97
Q

Percentage of prison inmates who misuse alcohol

A

> 40%

98
Q

Percentage of non fatal assaults associated with intoxication

A

50%

99
Q

Percentage of homicides associated with intoxication

A

66%

100
Q

Percentage of remanded men with a diagnosable personality disorder

A

78%

101
Q

Percentage of sentenced men with a diagnosable personality disorder

A

64%

102
Q

Percentage of female prisoners with a diagnosable personality disorder

A

50%

103
Q

Percentage of forensic patients with a diagnosable personality disorder

A

65%

104
Q

Most common personality disorder among prisoners

A

Antisocial PD

105
Q

Increased risk of violence among people with antisocial PD compared to the general population

A

10x higher rate

106
Q

Percentage of adults with IQ <90 who become delinquent

A

20%

107
Q

Percentage of adults with IQ 90-110 who become delinquent

A

9%

108
Q

Percentage of adults with IQ >110 who become delinquent

A

2%

109
Q

Specific offences more likely among perpetrators with low IQ

A

Sex offences
Fire setting

110
Q

Group (mild, moderate, severe) of patients with learning disability with the lowest rates of offence

A

Severe

111
Q

Definition of malingering

A

Intentional feigning of symptoms for specific gain

112
Q

Definition of Munchausen syndrome/factitious illness

A

Intentional feigning of symptoms without external gain, by people motivated to assume the sick role

113
Q

Eponymous name for morbid jealousy syndrome

A

Othello syndrome

114
Q

Syndrome characterised by a belief that the patient’s partner is unfaithful

A

Othello syndrome

115
Q

Eponymous name for erotomania

A

De Clerambault’s syndrome

116
Q

Sex more commonly affected by De Clerambault’s syndrome

A

Female

117
Q

Syndrome characterised by the erroneous belief that someone the patient knows of (often someone successful) is in love with them

A

De Clerambault’s syndrome

118
Q

Eponymous name for the syndrome of approximate answers

A

Ganser syndrome

119
Q

Symptoms of Ganser syndrome

A

Giving approximate answers to easy questions
Clouding of consciousness with disorientation
Pseudohallucinations
Amnesia for the crime

120
Q

People most commonly affected by Ganser syndrome

A

Prisoners, especially military prisoners
People absenting themselves from military duty

121
Q

Percentage of offenders who is a woman

A

20%

122
Q

Peak age for offending in females

A

14

123
Q

Peak age for offending in males

A

17-18

124
Q

Percentage of homicide victims who are male

A

55%

125
Q

Percentage of female prisoners who had attempted suicide in the year before their custody

A

19%

126
Q

Age of criminal responsibility in England and Wales

A

10

127
Q

Age of criminal responsibility in Scotland

A

8

128
Q

Age at which someone is classed as a juvenile offender

A

10-17

129
Q

Age at which someone is classed as a young offender

A

18-21

130
Q

Age at which someone is classed as an adult offender

A

21 and over

131
Q

Percentage of prisoners with diagnosable PTSD

A

20%

132
Q

Percentage of the general population who have been a victim of a crime in the past year

A

14%

133
Q

Percentage of patients with a severe mental illness who have been a victim of a crime in the last year

A

40%

134
Q

Percentage of people in police custody who had a mental illness at the time of arrest

A

2-5%

135
Q

Percentage of patients in police custody who had a severe mental illness at the time of arrest

A

1-2%

136
Q

Rate of psychosis among the prison population compared to the general population

A

10x higher in the prison population

137
Q

Most common age of people charged with exhibitionism

A

15-25

138
Q

Male to female conviction rate for any crime in the UK

A

5:1

139
Q

Most common demographics of victim when a woman with psychosis commits homicide

A

Relative <18 years old

140
Q

Increase in risk of being a victim of a crime if someone has a mental illness

A

5x higher risk

141
Q

Percentage of stalking victims who report the crime to the police

A

33%

142
Q

Proportion of patients discharged from a medium secure unit who are convicted of a violent crime within 5 years

A

1 in 6

143
Q

Proportion of elderly offenders who have a mental illness

A

20%

144
Q

Proportion of domestic violence victims that are male

A

40%

145
Q

Percentage of people convicted of homicide who are mental health patients

A

10%

146
Q

Percentage of children with conduct disorder who go on to have an adult diagnosis of personality disorder

A

50%

147
Q

Percentage of those convicted of indecent exposure who are new offenders

A

80%

148
Q

Percentage of violence in the community that can be accounted for by psychosis

A

5%

149
Q

Type of disorder kleptomania comes under

A

Impulse control disorder

150
Q

Sex which almost entirely commits the crime of child stealing

A

Women

151
Q

Most important risk factor for violence among patients with mental illness

A

Concomitant substance misuse

152
Q

Parental/environmental risk factors for expression of antisocial behaviour

A

Parental unemployment
High social deprivation
Low social cohesion in the neighbourhood
Multiple caregivers during development
Low parental affection

153
Q

Strongest predictor of future sexual offences

A

Past sexual offences

154
Q

Reliable predictors to identify which mothers will murder their children

A

None

155
Q

Most prevalent offender/victim combination for domestic abuse

A

Males assaulting females

156
Q

Most common delusion among stalkers

A

Delusion of love

157
Q

Most common psychiatric diagnosis among fire setters

A

Personality disorder

158
Q

Disorder which shares heritability with antisocial behaviour

A

Alcohol use disorder

159
Q

Description of threat control override symptoms

A

Patients feel they are being threatened or controlled due to hallucinations or delusions
Patients are then violent - however this is unusual

160
Q

Factor most associated with reoffending among perpetrators of child sexual abuse

A

Lack of victim empathy

161
Q

Personality disorders more commonly seen in elderly sex offenders compared to elderly non-offenders

A

Schizoid
Avoidant
Obsessive compulsive

162
Q

Most common forensic presentation of a conduct disorder

A

Shoplifting

163
Q

Most common offence in people with a learning difficulty

A

Offences against property

164
Q

Factors which increase the risk of assault in combination with stalking behaviour

A

Substance misuse
Male sex
Threats of violence
Presence of personality disorder
History of non-compliance with mental health treatment

165
Q

Definition of uxoricide

A

Killing someone’s own wife

166
Q

Percentage of shoplifters who reoffend after conviction

A

10%

167
Q

Percentage of prisoners who self harm during their prison term

A

10%

168
Q

Lifetime rate of any mental disorder among perpetrators of homicide

A

30%

169
Q

Patient related risk factors for violence in an inpatient psychiatric setting

A

Yong age
History of violence
Being detained
Substance misuse
Being in the acute phase of an illness

170
Q

Percentage of the male prison population with antisocial personality disorder

A

50%

171
Q

Percent of victims of the most serious sexual assault who know the perpetrator

A

90%

172
Q

Percentage of female prisoners with borderline personality disorder

A

20%

173
Q

Percentage of serious fires which are started deliberately

A

40%

174
Q

Percentage of serious crimes in the UK which are arson

A

1%

175
Q

Percentage of females who report being a victim of the most serious sexual assaults in the previous 12 months

A

0.5%

176
Q

Percentage of the prison population aged >60 with a diagnosis of personality disorder

A

30%

177
Q

Most common psychiatric diagnosis among prisoners aged >60

A

Depression

178
Q

Percentage of the prison population aged >60 with a diagnosis of dementia

A

1%

179
Q

Most common type of sexual offence

A

Sexual assault

180
Q

Two most serious sexual offences

A

Rape
Sexual assault with penetration

181
Q

UK case which highlights the role in police informing potential victims

A

Osman

182
Q

Percentage of males who report being a victim of the most serious sexual assaults in the previous 12 months

A

0.1%

183
Q

Most common victim of a homicide committed by a patient of mental health services

A

Acquaintance

184
Q

Most common crime in those with drug dependence

A

Shoplifting

185
Q

Most common crimes among people with autism spectrum disorder

A

Property damage
Arson

186
Q

Area of the brain where damage is particularly associated with a lack of impulse control

A

Prefrontal cortex

187
Q

Most common diagnosis among prisoners

A

Antisocial PD

188
Q

Most common diagnosis among homicide perpetrators

A

Antisocial PD

189
Q

Type of stalker who poses the greatest risk of sexual violence

A

Predatory

190
Q

Type of stalker most likely to have a delusional disorder

A

Rejected

191
Q

Factor associated with lowest risk of reoffending in exhibitionism

A

Late age of onset of offending

192
Q

Types of psychiatrists most at risk of being stalked

A

General adult
Forensic

193
Q

Percentage of male remand prisoners with functional psychosis

A

10%

194
Q

Percentage of male sentenced prisoners with functional psychosis

A

7%

195
Q

Percentage of people convicted of homicide who were psychotic at the time of the offence

A

5%

196
Q

Estimated suicide rate of prisoners in England and Wales

A

133 per 100,000 population per year

4. Forensic psychiatry (4 decks)

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