Cause-specific mortality in Finnish forensic psychiatric patients

Purpose: To analyze the causes of mortality among patients committed to compulsory forensic psychiatric hospital treatment in Finland during 1980-2009 by categorizing the causes of mortality into somatic diseases, suicides and other unnatural deaths.Materials and methods: The causes of mortality were analyzed among 351 patients who died during the follow-up. Standardized mortality ratio (SMR) was calculated as the ratio of observed and expected number of deaths by using the subject-years methods with 95% confidence intervals, assuming a Poisson distribution. The expected number of deaths was calculated on the basis of sex-, age- and calendar-period-specific mortality rates for the Finnish population.Results: The vast majority (249/351) of deaths were due to a somatic disease with SMR of 2.6 (mean age at death 61 years). Fifty nine patients committed suicide with a SMR of 7.1 (mean age at death 40 years). Four patients were homicide victims (mean age at death 40 years) and 32 deaths were accidental (mean age at death 52 years). The combined homicides and accidental deaths resulted in a SMR of 1.7.Conclusions: The results of this study point out that the high risk for suicide should receive attention when the hospital treatment and the outpatient care is being organized for forensic psychiatric patients. In addition, the risk of accidents should be evaluated and it should be assured that the patients receive proper somatic healthcare during the forensic psychiatric treatment and that it continues also in the outpatient setting.Peer reviewe

Naisten henkirikollisuus Suomessa : [katsausartikkeli]

Non peer reviewe

Legal outcomes of all suspected neonaticides in Finland 1980-2000

This nationwide study examined legal outcomes and possible psychiatric diagnoses of suspected cases of neonaticide. Neonaticide is commonly defined as the killing of a newborn on the day of its birth, and is considered to have not only a low prevalence but also a high level of concealed criminality. This hidden nature guided us to find out what the final legal outcomes of suspected neonaticide were. It was a comprehensive, retrospective, register-based study of all 44 cases of suspected neonaticide that occurred 1980-2000 as recorded by Statistics Finland. The 44 cases were ascribed to 40 suspects, three of whom died themselves during the offence. Twelve cases (27%) were eventually prosecuted and the accused convicted of neonaticide. Their mean sentence was 617 days (SD 216, range 300-1095 days). Fourteen offenders (35% of offenders) underwent a forensic psychiatric examination, out of which four (29%) were diagnosed with a psychotic disorder and 10 (71%) with a personality disorder. Six of the 14 women were not sentenced as criminally irresponsible and three of them were committed to involuntary hospital care. Nine cases (20% of cases) were still unsolved, and in eight (18%) cases the offence title had changed into something other than neonaticide. We concluded that since only 41% of suspected neonaticides completed the court process as neonaticides, the previous results from studies on neonaticide may present a subgroup of offenders, not the whole picture. Therefore, further discussion and research is needed to elucidate this perplexing, sad, and utterly redundant offence in modem society, to prevent it, and develop treatment programs for the offenders. (c) 2007 Elsevier Inc. All rights reserved.This nationwide study examined legal outcomes and possible psychiatric diagnoses of suspected cases of neonaticide. Neonaticide is commonly defined as the killing of a newborn on the day of its birth, and is considered to have not only a low prevalence but also a high level of concealed criminality. This hidden nature guided us to find out what the final legal outcomes of suspected neonaticide were. It was a comprehensive, retrospective, register-based study of all 44 cases of suspected neonaticide that occurred 1980-2000 as recorded by Statistics Finland. The 44 cases were ascribed to 40 suspects, three of whom died themselves during the offence. Twelve cases (27%) were eventually prosecuted and the accused convicted of neonaticide. Their mean sentence was 617 days (SD 216, range 300-1095 days). Fourteen offenders (35% of offenders) underwent a forensic psychiatric examination, out of which four (29%) were diagnosed with a psychotic disorder and 10 (71%) with a personality disorder. Six of the 14 women were not sentenced as criminally irresponsible and three of them were committed to involuntary hospital care. Nine cases (20% of cases) were still unsolved, and in eight (18%) cases the offence title had changed into something other than neonaticide. We concluded that since only 41% of suspected neonaticides completed the court process as neonaticides, the previous results from studies on neonaticide may present a subgroup of offenders, not the whole picture. Therefore, further discussion and research is needed to elucidate this perplexing, sad, and utterly redundant offence in modem society, to prevent it, and develop treatment programs for the offenders. (c) 2007 Elsevier Inc. All rights reserved.This nationwide study examined legal outcomes and possible psychiatric diagnoses of suspected cases of neonaticide. Neonaticide is commonly defined as the killing of a newborn on the day of its birth, and is considered to have not only a low prevalence but also a high level of concealed criminality. This hidden nature guided us to find out what the final legal outcomes of suspected neonaticide were. It was a comprehensive, retrospective, register-based study of all 44 cases of suspected neonaticide that occurred 1980-2000 as recorded by Statistics Finland. The 44 cases were ascribed to 40 suspects, three of whom died themselves during the offence. Twelve cases (27%) were eventually prosecuted and the accused convicted of neonaticide. Their mean sentence was 617 days (SD 216, range 300-1095 days). Fourteen offenders (35% of offenders) underwent a forensic psychiatric examination, out of which four (29%) were diagnosed with a psychotic disorder and 10 (71%) with a personality disorder. Six of the 14 women were not sentenced as criminally irresponsible and three of them were committed to involuntary hospital care. Nine cases (20% of cases) were still unsolved, and in eight (18%) cases the offence title had changed into something other than neonaticide. We concluded that since only 41% of suspected neonaticides completed the court process as neonaticides, the previous results from studies on neonaticide may present a subgroup of offenders, not the whole picture. Therefore, further discussion and research is needed to elucidate this perplexing, sad, and utterly redundant offence in modem society, to prevent it, and develop treatment programs for the offenders. (c) 2007 Elsevier Inc. All rights reserved.Peer reviewe

Psychosis and the Risk of Stranger Homicides

Funding Information: The study was funded by the Finnish Ministry of Social Affairs and Health, through the developmental fund for Niuvanniemi Hospital. IO has received a personal grant from the Finnish Medical Foundation, and ML has received personal grants from the Finnish Medical Foundation, Emil Aaltonen Foundation, and the Finnish Cultural Foundation. The funders were not involved in the conduct of the study or in the collection, management, analysis, or interpretation of the data. Funding Information: We thank Hannu Kautiainen (Medcare Oy) for his work with statistical analyses and Aija Räsänen for secretarial assistance. IO has received research funding from the Finnish Medical Foundation, honoraria from Ratiopharm, consultancy fees from Camurus, and has attended a congress trip provided by MSD. ML is an owner and board member of Genomi Solutions Ltd and Nursie Health Ltd, and has received honoraria, study grants, or other financial support from Sunovion, Orion Pharma, Janssen-Cilag, Otsuka Pharma, Lundbeck, Medscape, the Finnish Medical Foundation, Emil Aaltonen Foundation, and the Finnish Cultural Foundation. JT has participated in research projects funded by grants from Janssen-Cilag and Eli Lilly to his employing institution. He reports lecture fees from Eli Lilly, Janssen-Cilag, Lundbeck, and Otsuka; consultancy fees from EMA (European Medicines Agency), Fimea (Finnish Medicines Agency), and Lundbeck; He also notes receipt of grants from the Stanley Foundation and the Sigrid Jusélius Foundation. MLe and HP report no conflicts of interest.Psychosis increases the risk of committing homicide, but it remains unclear whether it also affects victim selection. Individual cases of stranger homicide elicit a lot of public attention and outrage, even though evidence of their incidence is scarce. Methods: Forensic psychiatric reports of 389 patients who had committed homicide in Finland during 1980-2014 were examined to determine the relationship between the offender and the victim. The stranger homicide incidence derived from perpetrators with psychosis was compared to a comparative incidence derived from a group of perpetrators without psychosis (other mental disorders were not excluded) over the time frame 2003-2014. Stranger homicide incidence rates were calculated using Finnish population averages of the study years, assuming a Poisson distribution and reported as per 100 000 person-years among potential victims in the Finnish general population. Results: Three hundred and eighty nine patients with psychosis had committed 414 homicides, with 40 complete stranger victims and 15 victims known for less than 24 h. Complete stranger homicide incidence committed by individuals with psychosis was 0.022 per 100 000 person-years and 0.13 for individuals without psychosis. When also including victims known for<24 h, the incidence was 0.031 for individuals with psychosis and 0.28 for individuals without psychosis per 100 000 person-years. Discussion: Nine out of ten stranger homicides are committed by individuals without psychosis. However, on the basis of a 3.1% prevalence of psychotic disorders in Finland, individuals with psychosis have about a 3- to 5-fold risk of committing stranger homicides as compared to individuals without psychosis.Peer reviewe

Exploring a new structured professional judgment measure (impulsivity measure related to violence) after an average follow-up of 10 years : A study of Finnish offenders

Background Identification of the risk factors underlying impulsivity related to violent acts is an essential component of risk assessment and management to reduce violent offending. Aims Our aim was to develop a clinically useful measure for assessing impulsivity related to violence. Our research questions were which items in the newly developed measure are associated with later violent recidivism and what is the measure's predictive validity? Methods A new scale, the impulsivity measure related to violence (IMP-V), was studied by completing the scale, blind to outcome, from information in the forensic psychiatric examination reports of 63 of a 1-year referral cohort of 181 Finnish offenders. Data on reoffending for up to 15 years after release were collected from official criminal records. Results The predictive accuracy of the IMP-V continuous ratings was 78% and for the categorical summary risk ratings 77%. Univariate analyses of categorical summary risk ratings of the risk factors revealed that, with two exceptions, each additional score on the IMP-V was associated with a significant increase in violence recidivism. Conclusions These preliminary results indicate that the IMP-V is a promising decision-enhancing guide for assessing the risk of violence in impulsive people and that the measure is worth developing for use with impulsivity-prone offenders and forensic psychiatric patients. The IMP-V organises information on the nature of impulsivity in violence-prone persons and thus also creates opportunities for more effective risk management.Peer reviewe

Neonaticide in the Courtroom – Room for Improvement? Conclusions Drawn from Austria and Finland's Register Review

This study analyses the psychological, clinical and criminal characteristics of neonaticide focusing on court verdicts with the aim of formulating recommendations for judicial guidelines. This study was register based, comprising all known neonaticides in Austria and Finland between 1995 and 2005. The cases (n = 28) were obtained by screening death certificates from coroner departments and analysing them alongside all further reports available. Five out of 21 convicted offenders were imprisoned with an average sentence of 1.65 years. A mental disorder, at the time of the offence, was diagnosed in half of the offenders (9/18) who underwent forensic examination. Of the total offenders, 14 were deemed responsible for the crime, one was deemed to have had diminished responsibility and three were considered not responsible for the crime. The main motive, determined by court evaluation, was an ?unwanted child?, followed by ?no motive?, ?fear of abandonment or a negative response from others? and 'mental overload'. The rate of repeated neonaticide was 13 per cent. Considering the rate of mental illness within the neonaticide offenders, we would recommend a treatment detention order instead of imprisonment or non-prosecution, as well as state-of-the-art guidelines for the court. ?Analyses the psychological, clinical and criminal characteristics of neonaticide focusing on court verdicts? Key Practitioner Messages Autopsies should be conducted for all suspected neonaticides. Forensic examinations should be performed by experts with knowledge and experience of neonaticide. There should be standardised forensic examinations using structured psychiatric and psychological methods by two independent experts. Neonaticide cases should be tried in specialised courts. A psychiatric treatment order should be made for all neonaticide offenders as a preventive measure to reduce reoffending and address the high psychological burden.Peer reviewe

Gender-Specific Risk Factors for Intimate Partner Homicide : A Nationwide Register-Based Study

Peer reviewe