Preference Heterogeneity in Experiments: Comparing the Field and Lab

Economists recognize that preferences can differ across individuals. We examine the strengths and weaknesses of lab and field experiments to detect differences in preferences that are associated with standard, observable characteristics of the individual. We consider preferences over risk and time, two fundamental concepts of economics. Our results provide striking evidence that there are good reasons to conduct field experiments. The lab fails to detect preference heterogeneity that is present in the field, obviously due to the demographic homogeneity of the lab. There are also differences in treatment effects measured in the lab and the field that can be traced to interactions between treatment and demographic effects. These can only be detected and controlled for properly in the field data. Thus one cannot simply claim, without additional empirical argument or assumption, that treatment effects estimated in the lab are reliable.

Violent and non-violent offending in patients with schizophrenia: Exploring influences and differences via machine learning

Objectives: The link between schizophrenia and violent offending has long been the subject of research with significant impact on mental health policy, clinical practice and public perception of the dangerousness of people with psychiatric disorders. The present study attempts to identify factors that differentiate between violent and non-violent offenders based on a unique sample of 370 forensic offender patients with schizophrenia spectrum disorder by employing machine learning algorithms and an extensive set of variables. Methods: Using machine learning algorithms, 519 variables were explored in order to differentiate violent and non-violent offenders. To minimize the risk of overfitting, the dataset was split, employing variable filtering, machine learning model building and selection embedded in a nested resampling approach on one subset. The best model was then selected, and the most important variables applied on the second data subset. Results: Ten factors regarding criminal and psychiatric history as well as clinical, developmental, and social factors were identified to be most influential in differentiating between violent and non-violent offenders and are discussed in light of prior research on this topic. With an AUC of 0.76, a sensitivity of 72% and a specificity of 62%, a correct classification into violent and non-violent offences could be determined in almost three quarters of cases. Conclusions: Our findings expand current research on the factors influencing violent offending in patients with SSD, which is crucial for the development of preventive and therapeutic strategies that could potentially reduce the prevalence of violence in this population. Limitations, clinical relevance and future directions are discussed. (C) 2021 The Author(s). Published by Elsevier Inc

Exploring Characteristics of Homicide Offenders With Schizophrenia Spectrum Disorders Via Machine Learning

The link between schizophrenia and homicide has long been the subject of research with significant impact on mental health policy, clinical practice, and public perception of people with psychiatric disorders. The present study investigates factors contributing to completed homicides committed by offenders diagnosed with schizophrenia referred to a Swiss forensic institution, using machine learning algorithms. Data were collected from 370 inpatients at the Centre for Inpatient Forensic Therapy at the Zurich University Hospital of Psychiatry. A total of 519 variables were explored to differentiate homicidal and other (violent and non-violent) offenders. The dataset was split employing variable filtering, model building, and selection embedded in a nested resampling approach. Ten factors regarding criminal and psychiatric history and clinical factors were identified to be influential in differentiating between homicidal and other offenders. Findings expand the research on influential factors for completed homicide in patients with schizophrenia. Limitations, clinical relevance, and future directions are discussed

Cariprazine in offender patient with acute psychosis and aggressive behavior: Case report

Background Cariprazine, a D3 preferring D3/D2 partial dopamine agonist, has shown to be effective in the treatment of acute psychosis as well as other symptom domains in schizophrenia spectrum disorders. There is also evidence suggesting a specific anti-hostility effect, starting from the first week of treatment. However, the substance has not yet been evaluated in offender populations with SSD. Case presentation A 48-year-old male offender patient with SSD suffered an acute exacerbation with paranoid delusions and aggressiveness towards other patients and staff members after reduction of his paliperidone dosage due to side effects. He had had multiple treatment attempts with other antipsychotic substances and now vehemently refused the recommended clozapine. However, he was willing to try cariprazine as he expected less side effects. The patient stabilized after establishing cariprazine in cross-titration with paliperidone and bridging with low-dose haloperidol to ensure the prompt effect. With this pharmacotherapeutic approach, positive symptoms as well as hostility and aggressiveness remitted. Conclusions The case illustrates the potential benefit of cariprazine in acutely exacerbated schizophrenic offenders to effectively treat psychotic symptomatology while sparing typical and atypical antipsychotics and promoting compliance due to fewer expected side effects. Due to their good efficacy even regarding aggression, the authors advocate an increased use of partial dopamine agonists in difficult, long-term courses, especially in offender patients who have already undergone various frustrating therapy attempts. Keywords cariprazine partial dopamine agonists case presentation schizophrenia forensic psychiatr

Offenders and non-offenders with schizophrenia spectrum disorders: Do they really differ in known risk factors for aggression?

Introduction: Individuals with schizophrenia spectrum disorders (SSD) have an elevated risk for aggressive behavior, and several factors contributing to this risk have been identified, e. g. comorbid substance use disorders. From this knowledge, it could be inferred that offender patients show a higher expression of said risk factors than non-offender patients. Yet, there is a lack of comparative studies between those two groups, and findings gathered from one of the two are not directly applicable to the other due to numerous structural differences. The aim of this study therefore was to identify key differences in offender patients and non-offender patients regarding aggressive behavior through application of supervised machine learning, and to quantify the performance of the model. Methods: For this purpose, we applied seven different (ML) algorithms on a dataset comprising 370 offender patients and a comparison group of 370 non-offender patients, both with a schizophrenia spectrum disorder. Results: With a balanced accuracy of 79.9%, an AUC of 0.87, a sensitivity of 77.3% and a specificity of 82.5%, gradient boosting emerged as best performing model and was able to correctly identify offender patients in over 4/5 the cases. Out of 69 possible predictor variables, the following emerged as the ones with the most indicative power in distinguishing between the two groups: olanzapine equivalent dose at the time of discharge from the referenced hospitalization, failures during temporary leave, being born outside of Switzerland, lack of compulsory school graduation, out- and inpatient treatment(s) prior to the referenced hospitalization, physical or neurological illness as well as medication compliance. Discussion: Interestingly, both factors related to psychopathology and to the frequency and expression of aggression itself did not yield a high indicative power in the interplay of variables, thus suggesting that while they individually contribute to aggression as a negative outcome, they are compensable through certain interventions. The findings contribute to our understanding of differences between offenders and non-offenders with SSD, showing that previously described risk factors of aggression may be counteracted through sufficient treatment and integration in the mental health care system

Die Schizophrenie im Entwurf der ICD-11 und Implikationen für die Beurteilung der Schuldfähigkeit

Die Veränderungen zur Klassifizierung schizophrener Psychosen in der Revision der ICD (International Classification of Diseases) gehen nicht mit einer grundsätzlichen Veränderung der bekannten Konzepte einher. Die Beurteilung der psychiatrischen Voraussetzungen der Schuldfähigkeit wird kaum beeinflusst. Die Aufgabe der Subtypen der Schizophrenie ist jedoch möglicherweise mit der Gefahr verbunden, dass die besonderen und individuellen Verläufe bei Betroffenen mit schizophrenen Psychosen in ihrem Variantenreichtum nicht mehr bekannt sein und wahrgenommen werden. Dies ist insbesondere problematisch in Fällen, in denen die psychotische Erkrankung nicht in dem weit verbreiteten und bekannten Phänomen „paranoid-halluzinatorisches Syndrom“ mündet, sondern eher mit Verhaltensauffälligkeiten einhergeht oder mit Veränderungen des Affektes, sprich den hebephrenen Verläufen. Die forensische Psychiatrie ist gefordert, das Wissen um solche Verläufe aktiv zu fördern, um jugendliche Straftäter, bei denen Psychopathologie mit „normalen“ Besonderheiten der Entwicklung verschränkt ist, adäquat als im Sinne der §§ 20 und 21 StGB „krankhaft seelisch gestört“ zu identifizieren und ihre sachgerechte forensisch-psychiatrische Beurteilung zu gewährleisten

Advantages of Machine Learning in Forensic Psychiatric Research—Uncovering the Complexities of Aggressive Behavior in Schizophrenia

Linear statistical methods may not be suited to the understanding of psychiatric phenomena such as aggression due to their complexity and multifactorial origins. Here, the application of machine learning (ML) algorithms offers the possibility of analyzing a large number of influencing factors and their interactions. This study aimed to explore inpatient aggression in offender patients with schizophrenia spectrum disorders (SSDs) using a suitable ML model on a dataset of 370 patients. With a balanced accuracy of 77.6% and an AUC of 0.87, support vector machines (SVM) outperformed all the other ML algorithms. Negative behavior toward other patients, the breaking of ward rules, the PANSS score at admission as well as poor impulse control and impulsivity emerged as the most predictive variables in distinguishing aggressive from non-aggressive patients. The present study serves as an example of the practical use of ML in forensic psychiatric research regarding the complex interplay between the factors contributing to aggressive behavior in SSD. Through its application, it could be shown that mental illness and the antisocial behavior associated with it outweighed other predictors. The fact that SSD is also highly associated with antisocial behavior emphasizes the importance of early detection and sufficient treatment

Maintaining social capital in offenders with schizophrenia spectrum disorder—An explorative analysis of influential factors

The importance of “social capital” in offender rehabilitation has been well established: Stable family and community relationships offer practical assistance in the resettlement process after being released from custody and can serve as motivation for building a new sense of self off the criminal past, thus reducing the risk of re-offending. This also applies to offenders with severe mental disorders. The aim of this study was to identify factors that promote or hinder the establishment or maintenance of social relationships upon release from a court-ordered inpatient treatment using a modern statistical method—machine learning (ML)—on a dataset of 369 offenders with schizophrenia spectrum disorder (SSD). With an AUC of 0.73, support vector machines (SVM) outperformed all the other ML algorithms. The following factors were identified as most important for the outcome in respect of a successful re-integration into society: Social integration and living situation prior to the hospitalization, a low risk of re-offending at time of discharge from the institution, insight in the wrongfulness of the offense as well as into the underlying psychiatric illness and need for treatment, addressing future perspectives in psychotherapy, the improvement of antisocial behavior during treatment as well as a detention period of less than 1 year emerged as the most predictive out of over 500 variables in distinguishing patients who had a social network after discharge from those who did not. Surprisingly, neither severity and type of offense nor severity of the psychiatric illness proved to affect whether the patient had social contacts upon discharge or not. The fact that the majority of determinants which promote the maintenance of social contacts can be influenced by therapeutic interventions emphasizes the importance of the rehabilitative approach in forensic-psychiatric therapy

Behavioral econometrics for psychologists ?

We make the case that psychologists should make wider use of structuraleconometric methods. These methods involve the development of maximumlikelihood estimates of models, where the likelihood function is tailored to thestructural model. In recent years these models have been developed for a wide rangeof behavioral models of choice under uncertainty. We explain the components ofthis methodology, and illustrate with applications to major models from psychology.The goal is to build, and traverse, a constructive bridge between the modelinginsights of psychology and the statistical tools of economists