Psychopathy subdomains in violent offenders with and without a psychotic disorder

Abstract

Background

Violence in psychosis has been linked to antisocial behavior and psychopathy traits. Psychopathy comprises aspects of interpersonal, affective, lifestyle, and antisocial traits which may be differently involved in violent offending by persons with psychotic disorders. We explored psychopathy subdomains among violent offenders with and without a psychotic disorder.

Methods

46 males, with a history of severe violence, with (n = 26; age 35.85 ± 10.34 years) or without (n = 20; age 39.10 ± 11.63 years) a diagnosis of a psychotic disorder, were assessed with the Psychopathy Checklist-Revised (PCL-R). PCL-R was split into subdomains following the four-facet model. Group differences in total and subdomain scores were analyzed with a general linear model with covariates.

Results

Total PCL-R scores did not differ between the groups (p = 0.61, Cohen’s d = 0.17). The violent offenders without psychotic disorders had higher facet 2 scores than the patient group with psychotic disorders (p = 0.029, Cohen’s d = 0.77). Facet 1, 3, or 4 scores did not differ between the groups. Controlling for age did not alter the results.

Conclusion

Patients with a psychotic disorder and a history of severe violence have lower affective psychopathy scores than violent offenders without psychotic disorders. This observation may point toward distinct underlying mechanisms for violence and may provide a target for focused treatment and prevention.

Keywords:

• Violence
• schizophrenia
• psychopathy
• psychosis
• forensic psychiatry

Acknowledgement

We performed this work on the Services for sensitive data (TSD), University of Oslo, Norway, with resources provided by UNINETT Sigma2 - the National Infrastructure for High-Performance Computing and Data Storage in Norway, and the South-Eastern Norway Regional Health Authority 2022080

Ethical approval

The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional guides on the care and use of laboratory animals.

Disclosure statement

OAA has received a speaker’s honorarium from Lundbeck and is a consultant to HealthLytix. All the other authors report no conflicts of interest.

Data availability statement

Due to ethical and data security issues related to the sensitive nature of the clinical data we are not allowed to share the data without specific IRB approval and data use agreements with the relevant institution. More information can be obtained through the corresponding author: Christina Bell (email address: [email protected]).

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This work was funded by The Research Council of Norway [OAA, #223273], and South-Eastern Norway Health Authorities [UKH, #2016044; UKH, #2019117; UKH, #2020100; OAA, #2017112].

Notes on contributors

Christina Bell

Christina Bell, psychiatrist, consultant at the psychiatric security unit at Gaustad, Oslo University Hospital, and PhD candidate at the University of Oslo since 2018. Research fields of interest include psychosis, psychopathy, violence, social cognition, and neuroimaging.

Jaroslav Rokicki

Jaroslav Rokicki, PhD, Researcher at the Centre of Research and Education in Forensic Psychiatry, Oslo University Hospital from 2020, with an interest in the application of machine learning methods for brain age prediction and to disentangle the role of violence in mental illnesses.

Gabriela Hjell

Gabriela Hjell, MD and resident in psychiatry. PhD candidate at the University of Oslo from 2018, focusing on biological correlates of agitation. Research fields of interest include severe mental disorders, cardiovascular comorbidity, and interplay between the immune system and mental health.

Thomas Fischer-Vieler

Thomas Fisher-Vieler, MD, PhD candidate at NORMENT/University of Oslo. Consultant psychiatrist in a flexible assertive community treatment (FACT) team at a public out-patient clinic in Bærum, Norway. Main interests are psychotic disorders, insight and self-disorders.

Ingrid Melle

Ingrid Melle, Psychiatrist, professor at the University of Oslo, senior consultant at Oslo University Hospital, main fields of interest: Etiology of Schizophrenia and bipolar disorder, treatment, and suicidality.

Ole A. Andreassen

Ole Andreassen, Psychiatrist, professor, and leader at the centre of excellence, Norment. His main fields of interest are mental health, somatic comorbidity, and genetics. Senior consultant at Nydalen district psychiatric centre, Oslo University Hospital.

Petter Andreas Ringen

Petter Andreas Ringen, Head of Division, Division of Mental Health and Addiction, Oslo University Hospital. Professor of Psychiatry, University of Oslo. Research interests: risk factors and understanding of psychosis and somatic comorbidity in severe mental illness.

Kirsten Rasmussen

Kirsten Rasmussen is professor emerita in forensic psychology at the Norwegian University of Science and Technology and working at St Olav’s hospital Centre for Research and Education in Forensic Psychiatry. Her research has focused mainly on mental health and violence, psychopathy, adult ADHD and violence risk assessment.

Hilde Dahl

Hilde Dahl, PhD, a senior research scientist at St. Olavs Hospital, Centre for research and education in forensic psychiatry, Trondheim, Norway, and Norwegian University of Science and Technology (NTNU), Department of Psychology and Department of Mental Health.

Christine Friestad

Christine Friestad, Psychologist, PhD, researcher at Centre of Research and Education in Forensic Psychiatry, Oslo University Hospital, Norway, and at University College of Norwegian Correctional Service, Oslo, Norway.

Unn K. Haukvik

Unn K. Haukvik, MD, PhD, associate professor of psychiatry, Institute for Clinical Medicine, University of Oslo. Head of the forensic psychiatry research group at the Centre of excellence Norwegian center for mental health research NORMENT. Senior researcher at the Centre for research and education in forensic psychiatry, Oslo University Hospital.