Different needs in patients with schizophrenia spectrum disorders who behave aggressively towards others depend on gender: a latent class analysis approach

Abstract

Background There is limited research with inconsistent findings on differences between female and male offender patients with a schizophrenia spectrum disorder (SSD), who behave aggressively towards others. This study aimed to analyse inhomogeneities in the dataset and to explore, if gender can account for those. Methods Latent class analysis was used to analyse a mixed forensic dataset consisting of 31 female and 329 male offender patients with SSD, who were accused or convicted of a criminal offence and were admitted to forensic psychiatric inpatient treatment between 1982 and 2016 in Switzerland. Results Two homogenous subgroups were identified among SSD symptoms and offence characteristics in forensic SSD patients that can be attributed to gender. Despite an overall less severe criminal and medical history, the female-dominated class was more likely to receive longer prison terms, similarly high antipsychotic dosages, and was less likely to benefit from inpatient treatment. Earlier findings were confirmed and extended in terms of socio-demographic variables, diseases and criminal history, comorbidities (including substance use), the types of offences committed in the past and as index offence, accountability assumed in court, punishment adjudicated, antipsychotic treatment received, and the development of symptoms during psychiatric inpatient treatment. Conclusions Female offender patients with schizophrenia might need a more tailored approach in prevention, assessment and treatment to diminish tendencies of inequity shown in this study.

Gender Differences in the Psychopharmacological Treatment of Forensic In-Patients With Schizophrenia

“…An interesting result of the present study is that men were more likely to have completed their occupational training, while women had an overall higher level of education. Since the onset of the disorder, objectified by the age at first hospitalization, showed no gender differences in contrast to previous studies with general psychiatric (14) as well as forensic samples (12), it can be assumed that the sampled women in this study experienced the onset of the disorder before graduating from college or university, leading to the typical sudden drop in social functioning and performance often accompanying schizophrenia onset (29), while men were able to complete occupational training on a lower educational level before falling ill. Thus, the integration in a fitting occupational setting as a treatment goal can be more challenging for women, which should carefully be considered when planning treatment or discharge.…”

“…Moreover, we were able confirm the finding that women treated in forensic psychiatry were more often separated from their spouses or divorced, which also was described earlier for female offenders with mental illnesses (28). In accordance with Günther et al (12), we therefore argue that more attention should be paid to the ability to maintain relationships when treating female offenders with schizophrenia.…”

“…The study was able to show that women with schizophrenia in forensic psychiatry differ from men in terms of sociodemographic characteristics quite remarkably, in that they have a higher level of education overall and are more likely to having entered into marriage prior to hospitalization. This corresponds not only with research on general psychiatric patients with schizophrenia ( 14), but also with results of a Swiss study on gender-specific differences in forensic patients with a schizophrenic disorder (12). Moreover, we were able confirm the finding that women treated in forensic psychiatry were more often separated from their spouses or divorced, which also was described earlier for female offenders with mental illnesses (28).…”

“…To our knowledge, only one study directly compares treatment characteristics of male and female forensic patients with schizophrenia. Günther et al (12) used a latent class analysis with 31 women and 329 men to show that the female-dominated class was equally likely to receive high antipsychotic dosages and was less likely to benefit from in-patient forensic treatment. Alas, they did not further elaborate on the specific psychopharmacological treatment strategies or examine possible side effects of the medication.…”

“…Regarding metabolic and neurological side effects, women have shown to be at greater risk for metabolic complications (13,16) and are generally more frequently affected by extrapyramidal side effects than men (17). When it comes to forensic samples, however, gender differences in psychopathology, especially concerning proneness for violent behavior, seem to diminish (12), suggesting that female forensic patients with schizophrenia are quite similar to their male counterparts in that respect.…”