Severe behavioral problems, aggression, unlawful behavior, and uncooperativeness make the forensic psychiatric population both hard to treat and study. To fine-tune treatment and evaluate results, valid measurement is vital. The Brief Psychiatric Rating Scale-Extended (BPRS-E) is a widely used scale for assessing psychiatric symptoms, with a stable factor structure over various patient groups. For the first time, its usefulness for forensic psychiatric patients was studied by means of an exploratory factor analysis on 302 patients in a penitentiary psychiatric center. A five-factor solution fitted the data best and showed large overlap with previous research done in both in- and outpatient populations with schizophrenia and mixed diagnoses. Around 45% of the patients did not fully comply. Items relying most on self-report caused the most non-adherence, possibly because of difficulty with verbalizing distress. These items loaded on the factors psychosis and affect. The BPRS-E is a suitable instrument for forensic use. Future research and clinical practice should focus on alignment with forensic patients to improve measurement, understanding, and eventually therapeutic interventions.

There is evidence that psychiatric patients with psychotic or manic disorders who are incarcerated suffer from the same symptoms as psychiatric patients who are treated in the community. There are also indications that their symptoms might be more severe. The aim of this study was to examine the severity of psychotic and manic symptoms, as well as to collect information about the emotional functioning of patients admitted to a prison psychiatric ward. Incarcerated patients with a diagnosis of psychotic or a manic disorder were examined with the Brief Psychiatric Rating Scale-Expanded (BPRS-E). With the scores of 140 assessments, a symptom profile was created using the domains of the BPRS-E. This profile was compared with the clinical profile of three nonincarcerated patient groups described in literature with a diagnosis in the same spectrum. We found high scores on positive and manic psychotic symptoms and hostility, and low scores on guilt, depression, and negative symptoms. High scores on manic and psychotic symptoms are often accompanied by violent behavior. Low scores on guilt, depression, and negative symptoms could be indicative of externalizing coping skills. These characteristics could complicate treatment in the community and warrant further research along with clinical consideration.

Aim A prospective design was used to investigate the relationship of current psychiatric symptoms of incarcerated people with serious mental illness (SMI) and aggressive behavior on a penitentiary ward for crisis intervention. Methods One hundred sixty detainees with SMI, detained in a high-security penitentiary psychiatric facility, were screened every 2 weeks with the Brief Psychiatric Rating Scale-Extended (BPRS-E) by trained clinicians, to ensure that the data on psychiatric symptoms were up-to-date. Aggressive behavior was registered with the Staff Observation Aggression Scale–Revised. A binary logistic regression analysis was performed to examine the relationships between factor scores of the BPRS-E and aggressive behavior. Results Significant relationships between the BPRS-E factor hostility, antisocial traits, and aggressive incidents were found, but not between the positive symptoms or manic factor scores and aggressive incidents. Discussion Symptoms of SMI measured with the BPRS-E did not help to explain the occurrence of aggressive behavior. This is not in line with what is commonly found. The implication is that it can be expected that this population will display aggressive behavior but that symptoms do not help in predicting when this will occur. In addition, hostility and antisocial traits were related to aggressive behavior. For this specific population, an interactional approach might be more effective in the management of aggression than treatment of symptoms of SMI.