Can measures of cognitive flexibility and inhibition distinguish forensic psychiatric inpatients from prisoners?

Abstract

We investigated whether forensic psychiatric inpatients can be distinguished from prisoners and healthy controls on the basis of their performance on cognitive tasks measuring cognitive flexibility (with a reversal learning task) and inhibition (with a stop signal task). Forensic psychiatric inpatients were expected to perform worse compared to prisoners. This study was based on pre-existing data from N = 241 males (119 forensic psychiatric inpatients, 57 prisoners and 65 healthy controls). We fitted logistic generalized linear models to group membership data using outcome measures from a stop signal task and a reversal learning task to examine whether deficiencies in inhibition and cognitive flexibility predict membership of the group of forensic psychiatric inpatients. Neurocognitive measures of cognitive flexibility, but not inhibition, had predictive value for group membership. This suggests that the capacity for cognitive flexibility may help differentiate between forensic subpopulations and healthy controls. Furthermore, our results highlighted substantial heterogeneity in cognitive performance in inhibition and cognitive flexibility within different offender groups. This study indicates that forensic subpopulations can be adequately differentiated based on neurocognitive measures of cognitive flexibility. In a broad sense, this study is an example of how neurocognitive approaches can contribute to refining diagnosis in forensic psychiatry.

Charting cognitive characteristics in forensic psychiatric outpatients.

“…Weaknesses in these cognitive domains have robust positive associations with aggressive and criminal behavior (Morgan & Lilienfeld, 2000; Ogilvie et al, 2011; Portnoy et al, 2013; Janes et al, 2024; Jansen & Franse, 2024). Similar results have been obtained in forensic (psychiatric) inpatient populations as well (Molleman, Driessen, et al, 2022; Molleman, Molleman, et al, 2022; Shumlich et al, 2019). However, recent research did not demonstrate any decrements in memory, orientation, language, and visuospatial skills within the prison and outpatient forensic (psychiatric) population (Fassaert et al, 2022).…”

“…Even though several studies showed that forensic patients may have difficulties with abstract reasoning (Morgan & Lilienfeld, 2000; Ogilvie et al, 2011; Portnoy et al, 2013; Shumlich et al, 2019), we did not find any differences between the ForFACT group and the control group on the abstract reasoning item. Recent studies that examined similar forensic psychiatric populations compared to healthy controls (Molleman, Driessen, et al, 2022; Molleman, Molleman, et al, 2022; Shumlich et al, 2019), also found no differences in performance between the groups on items of abstract reasoning. Even though abstract reasoning is believed to be strongly associated with EF (e.g., Wachholz & Yassuda, 2011), there is no consensus in the literature.…”

“…(a) We predicted that ForFACT patients would perform worse than healthy controls in overall cognitive functioning, quantified using performance measures on a cognitive screening task. (b) Furthermore, we hypothesized that ForFACT patients would perform specifically worse than healthy controls on items that measure the following specific cognitive domains: EF, attention/concentration, working memory, language and abstract reasoning (see e.g., Molleman, Driessen, et al, 2022; Molleman, Molleman, et al, 2022; Morgan & Lilienfeld, 2000; Ogilvie et al, 2011; Portnoy et al, 2013; Shumlich et al, 2019; Smeekens et al, 2021). We did not expect any differences in the performance of ForFACT patients on items that assess other cognitive domains (i.e., episodic memory, orientation, and visuospatial abilities) compared to healthy controls.…”

Alterations in executive functions in inmates convicted for violent behavior: a systematic review

“…Improvements in cognitive flexibility, working memory, and planning may have a significant impact on reducing violent behavior among inmates (Vadini et al, 2018 ; Molleman et al, 2022 ; Romero-Martínez et al, 2022 ). Specifically, enhancing these executive functions could help prisoners regulate their emotions, inhibit impulsive behavior, and plan and execute non-violent problem-solving strategies (Seruca and Silva, 2016 ; Valizadeh et al, 2020 ).…”

“…Specifically, enhancing these executive functions could help prisoners regulate their emotions, inhibit impulsive behavior, and plan and execute non-violent problem-solving strategies (Seruca and Silva, 2016 ; Valizadeh et al, 2020 ). As a result, prisoners may be less likely to engage in violent behavior, both within prison and after their release (Meijers et al, 2018 ; Molleman et al, 2022 ). Moreover, improved cognitive functioning can lead to better decision-making skills and increased self-control, which are crucial for successful reintegration into society.…”