Janusz Heitzman

Background: Deliberate self-harm (DSH) is a major public health concern among patients with schizophrenia spectrum disorders (SSDs). Although forensic patients with SSD show high rates of DSH, they remain under-represented in suicidology research, and differences in risk profiles compared with non-forensic patients are poorly understood. Objective: To compare sociodemographic, clinical, neuropsychological and criminological correlates of lifetime DSH between forensic and non-forensic patients with SSD and identify subgroup-specific vulnerability markers. Methods: Data were drawn from the multinational EU-VIORMED study across five European countries. Participants (N=392) aged 18–65 years with a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnosis of SSDs completed standardised assessments. Lifetime DSH was measured dichotomously. Separate LASSO logistic regression models identified the strongest correlates of DSH in forensic and non-forensic subsamples. Findings: Lifetime DSH prevalence was high in both groups (45.9% forensic; 39.5% non-forensic). In forensic patients, the strongest correlate was comorbid personality disorder (β=0.78), followed by functional impairment (β=0.02–0.26). In non-forensic patients, interpersonal victimisation (β=0.85) was the strongest correlate, followed by personality disorder (β=0.71), male gender (β=0.69), lifetime substance use (β=0.37) and psychopathological indicators (PANSS (Positive and Negative Syndrome Scale) items; β=−0.10–0.32). Overall, DSH in forensic patients was more strongly associated with personality pathology and functioning, whereas in non-forensic patients it was linked to trauma, clinical severity and sociodemographic factors. Conclusions: Despite similar DSH prevalence, forensic and non-forensic SSD patients showed distinct patterns of associated factors, suggesting different mechanisms of risk. Clinical implications: Suicide prevention in SSD should adopt tailored risk formulations, emphasising personality pathology and functioning in forensic settings and trauma-informed, integrated care in non-forensic services.

Głównym celem pracy było ukazanie znaczenia impulsywności jako podłoża zachowań agresywnych przejawianych przez osoby ze spektrum schizofrenii ze szczególnym zwróceniem uwagi na jej biologiczne uwarunkowania, w tym genetyczne. Badania obrazowe ośrodkowego układu nerwowego pozwalają na zlokalizowanie ośrodków odpowiedzialnych za poszczególne typy impulsywności oraz za modulowanie reakcji impulsywnych. Do nadmiernej impulsywności mogą przyczyniać się zaburzenia w przekaźnictwie serotoninergicznym, dopaminergicznym i noradrenergicznym i zaburzone funkcjonowanie innych szlaków neuroprzekaźnikowych na podłożu zmian genetycznych (COMT, Ala72Ser, Val158Met i C957T, SLC6A4). Zaobserwowano cechy świadczące o genetycznym zróżnicowaniu wśród osób wykazujących odmienne formy wzmożonej impulsywności: motorycznej, poznawczej i wynikającej z braku planowania, które można wyjaśnić na poziomie molekularnym. Wśród genów predysponujących do wystąpienia zaburzeń psychicznych i neurorozwojowych, którym towarzyszy nasilona impulsywność sprzyjająca zachowaniom agresywnym wymienia się neuroliginy i neureksyny. Podstawę do takich hipotez dają wyniki analiz prowadzonych na modelach zwierzęcych. Należy zakładać, że wyniki dalszych badań genetycznych w tym zakresie pozwolą na bardziej precyzyjne określenie ryzyka agresji ze strony sprawców z zaburzeniami psychotycznymi. Prawdopodobnie w przyszłości pozwoli to na opracowanie bardziej skutecznych i zindywidualizowanych programów terapeutycznych, ukierunkowanych na obniżenie ryzyka zachowań niebezpiecznych w tej grupie sprawców, sprawniejsze wykonywanie środków zabezpieczających, a tym samym obniżenie kosztów leczenia psychiatrycznego niepoczytalnych sprawców czynów zabronionych.

Item Response Theory (IRT) describes a set of statistical models describing how individual items in a test or questionnaire relate to the underlying characteristic or trait that the test claims to measure. Until now IRT models have not been applied to the Positive and Negative Syndrome Scale (PANSS) in forensic and general psychiatric samples to establish its psychometric properties and explore the link between psychotic symptom severity and violent behavior in schizophrenia. This study investigated patients with schizophrenia spectrum disorders and a history of violence from forensic institutions and non-violent patients from general psychiatric settings in five European countries. A total of 398 participants were assessed using the PANSS. IRT analysis revealed a poor model fit for the Partial Credit Model (PCM) with considerably disordered thresholds for most items. Differential item functioning (DIF) revealed significant differences between the two groups, notably for items hypothetically linked to violence risk, such as delusions and hostility. These findings reveal potential limitations when trying to compare PANSS scores across these two clinical populations.

Cel pracy: Zasadniczym celem pracy była ocena częstości występowania zespołu metabolicznego oraz poszczególnych jego składowych u pacjentów odbywających środek zabezpieczający, leczonych lekami przeciwpsychotycznymi w mono- lub politerapii. Dodatkowe cele obejmowały analizę związków pomiędzy występowaniem zespołu metabolicznego a wiekiem pacjentów, rozpoznaniem psychiatrycznym, nadwagą lub otyłością, obecnością uzależnień od substancji psychoaktywnych.Metoda: W badaniu uczestniczyło 61 pacjentów Kliniki Psychiatrii Sądowej, w tym 9 kobiet i 52 mężczyzn, odbywających środek zabezpieczający w okresie od września 2019r. do sierpnia 2021r. Dwukrotnie przeprowadzono pomiary wszystkich parametrów zespołu metabolicznego oraz BMI, na początku pobytu w Klinice i po półrocznym leczeniu atypowymi lekami przeciwpsychotycznymi. Następnie wykonano odpowiednie statystyczne analizy porównawcze.Wyniki: Nie stwierdzono związku pomiędzy występowaniem zespołu metabolicznego a wiekiem badanych, diagnozą medyczną, uzależnieniami od substancji psychoaktywnych, w tym paleniem papierosów. Nie potwierdzono, aby przewlekłe stosowanie atypowych leków przeciwpsychotycznych przy równolegle prowadzonych oddziaływaniach profilaktycznych i prozdrowotnych w warunkach detencji prowadziło do rozwoju zespołu metabolicznego a także powodowało nasilenia jego objawów, poza wyraźnym wzrostem obwodu talii oraz wzrostem BMI.Wnioski: Systematyczne pomiary BMI oraz obwodu talii podczas terapii atypowymi lekami przeciwpsychotycznymi mogą być trafnymi narzędziami w ocenie ryzyka zespołu metabolicznego. Długotrwałe hospitalizacje w ramach detencji powinny uwzględniać oddziaływania psychoedukacyjne ukierunkowane na minimalizowanie powikłań metabolicznych farmakoterapii.

Aims: The purpose was to compare the frequency of needs of patients with schizophrenia in forensic services across five European countries as assessed by both the patients and their care staff. Methods: Patients with schizophrenia and a history of significant interpersonal violence were recruited from forensic psychiatric services in Austria, Germany, Italy, Poland and England. Participants’ needs were assessed using the Camberwell Assessment of Needs—Forensic Version (CANFOR). Multiple linear regression analyses were used to identify predictors of numbers of needs. Results: In this sample, (n = 221) the most commonly reported need according to patients (71.0%) and staff (82.8%) was the management of psychotic symptoms. A need for information was mentioned by about 45% of staff and patients. Staff members reported a significantly higher number of total needs than patients (mean 6.9 vs. 6.2). In contrast, staff members reported a significantly lower number of unmet needs than patients (mean 2.0 vs. 2.5). Numbers of total needs and met needs differed between countries. Unmet needs as reported by patients showed positive associations with the absence of comorbid personality disorder, with higher positive symptom scores and lifetime suicide or self-harm history. Significant predictors of unmet needs according to staff were absence of comorbid personality disorder and higher positive as well as negative symptom scores according to PANSS. Conclusions: Staff rated a significantly higher number of total needs than patients, while patients rated more unmet needs. This indicates that patients’ self-assessments of needs yield important information for providing sufficient help and support.

Background: Homicide combined with subsequent suicide of the perpetrator is a particular form of interpersonal violence and, at the same time, a manifestation of extreme aggression directed against oneself. Despite the relatively well-described individual acts of homicide and suicide, both in terms of psychopathology and law, acts of homicide and subsequent suicide committed by the same person are not well-studied phenomena. The importance of emotional factors, including the influence of mental state deviations (psychopathology), on this phenomenon, is discussed in the literature, but still there is relatively little data with which to attempt neuropathological assessments of the brains of suicide killers. This paper is dedicated to the issue based on the neuropathological studies performed. Methods: We analyzed a group of murder–suicides using histochemical and immunohistochemical methods. Results: The results of our research indicate the presence of neurodegenerative changes including multiple deposits of ß-amyloid in the form of senile/amyloid plaques and perivascular diffuse plaques. Conclusions: Neurodegenerative changes found in the analyzed brains of suicide killers may provide an interesting starting point for a number of analyses. The presence of neurodegenerative changes at such a young age in some murderers may suggest preclinical lesions that affect cognitive functions and are associated with depressed moods.

Background: The relationship between schizophrenia and violence is complex. The aim of this multicentre case–control study was to examine and compare the characteristics of a group of forensic psychiatric patients with a schizophrenia spectrum disorders and a history of significant interpersonal violence to a group of patients with the same diagnosis but no lifetime history of interpersonal violence.Method: Overall, 398 patients (221 forensic and 177 non-forensic patients) were recruited across five European Countries (Italy, Germany, Poland, Austria and the United Kingdom) and assessed using a multidimensional standardised process.Results: The most common primary diagnosis in both groups was schizophrenia (76.4%), but forensic patients more often met criteria for a comorbid personality disorder, almost always antisocial personality disorder (49.1v.0%). The forensic patients reported lower levels of disability and better social functioning. Forensic patients were more likely to have been exposed to severe violence in childhood. Education was a protective factor against future violence as well as higher levels of disability, lower social functioning and poorer performances in cognitive processing speed tasks, perhaps as proxy markers of the negative syndrome of schizophrenia. Forensic patients were typically already known to services and in treatment at the time of their index offence, but often poorly compliant.Conclusions: This study highlights the need for general services to stratify patients under their care for established violence risk factors, to monitor patients for poor compliance and to intervene promptly in order to prevent severe violent incidents in the most clinically vulnerable.

Objectives. The outbreak of the COVID-19 pandemic at the end of 2019, caused by the SARS-CoV-2 virus, manifested in the form of severe acute respiratory failure, also results in a reduced mental condition and resilience on an unprecedented scale and with consequences that are difficult to assess. Literature review. It has been observed that the clinical picture of mental disorders manifested in reaction to confrontation with the pandemic trauma does not strictly coincide with the diagnostic criteria of commonly used diagnoses, i.e. acute stress reaction (ASR), acute stress disorder (ASD), and post-traumatic stress disorder (PTSD). In the case of PTSD in particular, it is difficult to adopt unambiguous criteria for a precise diagnosis during the ongoing pandemic. The occurrence of mental disorders in response to pandemic trauma depends on individual risk factors, the nature of traumatic stress, and environmental factors. Conclusions. The phenomenon of a widespread population confrontation with the pandemic, more than the intensity of the stressor itself, prompts us to recall the possibility of effective pharmacological support in already existing pandemic mental disorders and to prepare for pharmacological intervention against mental disorders that will manifest themselves after the pandemic has expired.