Early detection of serial arsonists can be challenging for forensic professionals. Serial arsonists account for nearly 20% of all fire setters, but only 1% of these individuals are diagnosed with pyromania and receive appropriate treatment. There is an urgent need for accurate identification to enable more effective management, thus preventing the significant ecological and economic damage caused by these criminal acts.We present a case of a young serial arsonist responsible for setting 12 deliberate fires over a period of four weeks. The individual had been diagnosed with pyromania in pre-adolescence but was not diagnosed with it during the post-arrest assessment. Using psychiatric and forensic reports, we applied a validated 44-item classification methodology for incendiary acts. We performed multidimensional scaling analysis to examine the characteristics of serial fire setting.In this case, alcohol abuse and episodes of arson without periods of emotional calm were recurrent. Advanced skills in arson were demonstrated, with a variety of scenarios targeting both objects and people.The implementation of a classification methodology allowed us to identify additional features that distinguish this case beyond the diagnosis of pyromania. This approach paves the way for more appropriate and effective interventions, particularly those focused on controlling impulsivity.

The gendered general strain theory posits that differences in delinquency across gender are due to differences in coping with negative emotions. The present study tests its validity over a 10-year follow-up. We measured exposure to strain, levels of anxiety/depression, anger/irritability, and delinquent behaviors through questionnaires and interviews during residential care (T1) and then 10 years later (T2) in a sample of 80 men and 54 women who were placed in youth welfare and juvenile justice institutions in Switzerland during childhood/adolescence. We observed that, in men, less delinquency at T1 and more symptoms of anxiety/depression at T1 are related to less delinquency at T2. In women, none of the emotional variables nor strain predicted delinquency over time. Results give important insights regarding the risk factors related to long-term delinquency in men but only partially support the gendered general strain theory.

Measurement of patient-to-staff violence (PSV) is essential for the institution to prevent negative outcomes and provide effective interventions. Although there are several approaches to doing this in psychiatry, little is known about how well they adapt to different types of wards. The role of gender and age also needs further investigation. The present study aimed to examine and compare characteristics that contribute to the objective and subjective measurement of the severity of PSV in adult (AP) and geriatric (PG) psychiatric wards. Results show that 70% of the reported violence over 30 months (N = 589) was PSV, mostly perpetrated by male patients against nurses. Objective severity ratings were higher in PG than in AP wards, and conversely, subjective ratings were higher in AP than in PG wards. The findings support the systematic measurement of PSV in psychiatric wards and highlight the need for targeted interventions to address the risks associated with minimizing violence.

Purpose: Both the resting heart rate (RHR) and the callous-unemotional (CU) traits have been associated with juvenile delinquency, however the effect of their interaction is not yet clear.Methods: Four hundred and twenty-three institutionalized adolescents divided into early adolescents (10-14 years, n = 133), late adolescents (15-17 years, n = 286), and young adults (18-22 years, n = 136) participated in the study. RHR was measured using a wristband, and CU traits and delinquency history were assessed using self-reported questionnaires. Moderation analysis was performed to understand how the combination between RHR and CU is associated to offending.Results: CU traits were associated with offending at all ages. The interactions between RHR and CU traits were significantly related to the likelihood of offending in the early and the late adolescent. The highest likelihood of offending is related to high CU traits combined with low RHR in early adolescents and with high RHR in late adolescents.Conclusions: These findings provide further insight in the relationship between psychopathic traits and bio-physiological maturation in explaining juvenile delinquency.

Objective:Within a longitudinal study (10-year follow-up), we aim to examine the role of anger/irritability and limited prosocial emotion/callous-unemotional traits in predicting externalizing symptoms and adjustment problems in individuals formerly in youth residential care institutions.Method:These dimensions were assessed in 203 young adults, with baseline assessments during youth residential care and a follow-up 10 years later.Results:In general, emotional problems and psychopathological symptoms did not reduce over time. Analyses of regression revealed that a younger age at baseline, anger/irritability both at baseline assessment, and regarding their aggravation over time refer to significant predictors of the level of externalizing symptoms at 10-year follow-up (R 2 = 0.431) and the worsening of externalizing symptoms over time (R 2 = 0.638). Anger/irritability has been observed to be a significant predictors of both the level of adjustment problems at 10-year follow-up (R 2 = 0.471) and its worsening over time (R 2 = 0.656).Discussion:Our results suggest that dysregulation of anger/irritability is a key factor in the prediction of long-term externalizing symptoms and adjustment problems as well as its worsening over time. Possible implications for intervention and prevention are discussed.

Dynamics of the autonomic nervous system (ANS) are hypothesized to play a role in the emergence of interpersonal violence. In the present study, we examined continuous activities of the inhibitory parasympathetic pathway of the ANS through the root mean square of successive differences between normal heartbeats (RMSSD) in 22 male offenders who committed interpersonal violence and 24 matched controls from the general population across three successive phases: resting baseline, while performing an emotional Go/No-Go task, and post-task recovery. Results showed that across the three phases, the offender group presented lower RMSSD at baseline ( p FDR = .003; Cohen’s d = − 1.11), but similar levels during the task, attributed to a significant increase in their RMSSD level ( p FDR = .027, Cohen’s d = − 1.26). During recovery, while no distinction between the two groups was found, both groups showed signs of recovering toward baseline values. These findings suggest that violent incarcerated offenders can flexibly engage parasympathetic resources to meet environmental challenges. This underscores the necessity of considering parasympathetic dynamics and its respective mobilization/flexibility to better understand ANS profiles underlying interpersonal violence as well as its potential utility in designing more tailored interventions.

Die vorliegende Studie untersucht die jugendspezifische Gutachtenspraxis auf nationaler Ebene in der Schweiz mittels einer Online-Umfrage. Die Antworten von 35 Experten zeigen, dass 83% standardisierte Instrumente in Verbindung mit dem klinischen Gespräch zur Risikoeinschätzung verwenden, aber nur die Hälfte von ihnen das Vorhandensein von Schutzfaktoren beurteilen. Darüber hinaus zeigen die Ergebnisse die Notwendigkeit, das Expertenwissen in zwei Bereichen zu verbessern: a) der Einbezug der Bedeutung von Defiziten im Bereich der prosozialen Emotionen, einem Marker, der anerkanntermassen mit Verhaltensstörungen bei Minderjährigen in Verbindung gebracht wird, und b) die Berücksichtigung der Perspektiven, die neue biopsychosoziale Ansätze im Bereich der Jugendkriminalität bieten.

Background: Adolescents in the child welfare and juvenile justice systems show high rates of substance-use disorders. Yet, little is known about the association between childhood adversities and impulsive behavior involving substance-use disorders in shared residential care in the child welfare and juvenile justice systems. Objective: The aim of this study is to investigate the prevalence of substance-use disorders and their association with childhood adversities and impulsive behavior among child welfare-and juvenile justice-involved adolescents in residential care. Method: A total of 386 adolescents placed into Swiss residential care by the child welfare and juvenile justice systems (37.0% girls; age range = 10-18 years; mean age = 15.41 years) were studied. Substance-use disorders and childhood adversities were categorically assessed using the Kiddie Schedule for Affective Disorders and Schizophrenia - Present and Lifetime Version. Impulsive behavior was dimensionally measured with the Youth Psychopathic Traits Inventory. Statistical methods included descriptive analyses and logistic regression analyses. Results: Juvenile justice-involved adolescents showed higher rates of any substance-use disorder compared to child welfare-involved counterparts (38% vs. 20%; chi(2) = 22.21, p < 0.001). Higher numbers of childhood adversities were found among child welfare (U = 3039, p < 0.001) and juvenile justice (U = 309.5, p < 0.001) youths with substance-use disorders compared to those without substance-use disorders. Impulsive behavior was related to substance-use disorders among both the child welfare (B = 0.61, SE = 0.15, p < 0.001) and the juvenile justice groups (B = 0.40, SE = 0.17, p = 0.02). Conclusion: Considering the high rates of substance-use disorders in both the child welfare and the juvenile justice samples, this study highlights that treating impulsive behavior and incorporating trauma-informed care for childhood adversities may reduce substance-use disorders among youths in residential care. Implications for care system practice and avenues for future research are discussed.

Since lack of empathy is an important indicator of violent behaviors, researchers need consistent and valid measures. This study evaluated the practical significance of a potential physiological correlate of empathy compared to a traditional self-report questionnaire in 18 male violent offenders and 21 general population controls. Empathy skills were assessed with the Interpersonal Reactivity Index (IRI) questionnaire. Heart-Rate Variability (HRV) was assessed with an electrocardiogram. The RMSSD (Root Mean Square of the Successive beat-to-beat Differences), an HRV index implicated in social cognition, was calculated. There were no group differences in IRI scores. However, RMSSD was lower in the offender group. Positive correlations between RMSSD and IRI subscales were found for controls only. We conclude that psychometric measures of empathy do not discriminate incarcerated violent offenders, and that the incorporation of psychophysiological measures, such as HRV, could be an avenue for forensic research on empathy to establish translatable evidence-based information.

Introduction.- The risk assessment is a major issue for the mission of judicial experts. Research contend that to such assessment may improve by using consensus ratings. Objectives. - (a) To compare consensual and individual assessment relapse 'predictive validities; (b) To better understand the decision-making process in consensual protective and risk factors assessment. Method. - Two researchers evaluated 160 forensic reports independently, then met to discuss their scores and reach a consensus on the scoring for all the instruments followed by a consensus time. We use AUC curves and structural equation models to analyses predictive validity over a follow-up period of 3 years after release from prison. We carried out a content' thematic qualitative analysis of consensual decision-making process. Results. - Consensus ratings did not improve the predictive validity of violent or general relapse, but it did identify the most difficult factors to assess, the points of disagreement and the assessment subjective dimensions. Consensus ratings also facilitated mutual learning and assessment 'resetting. Conclusion. - Our results suggest that above consensus or individual ratings, risk assessment prediction validity is related to the tool used and the summative logic of the factors. However, discussions among reviewers introduced rigor and lead to more accurate argumentations of risk factors ratings. (C) 2019 Elsevier Masson SAS. All rights reserved.

Objective: Intellectual disability (ID) is described as a general slowness in behavior and an inadequacy in adaptive skills. The present study examines whether behavioral slowness in ID could originate from abnormal complexity in brain signals. Methods: Participants (N = 29) performed a reaction times (RTs) task assessing their individual information processing speeds. Half of the participants had moderate intellectual disability (intelligence quotient (IQ) < 70). Continuous electroencephalogram recording during the resting period was used to quantify brain signal complexity by approximate entropy estimation (ApEn). Results: For all participants, a negative correlation between RTs and IQ was found, with longer RTs coinciding with lower IQ. This behavioral slowness in ID was associated with increased temporal regularity in electrocortical brain signals. Conclusions: Behavioral slowness in ID subjects is closely related to lower brain signal complexity. Significance: Brain signal ApEn is shown to correspond with processing speed for the first time: in ID participants, the higher the regularity in brain signals at rest, the slower RTs will be in the active state. ID should be understood as a lack of lability in the cortical transition to the active state, weakening the efficiency of adaptive behavior. (C) 2020 International Federation of Clinical Neurophysiology. Published by Elsevier B.V.

ObjectifDéterminer s’il est possible d’identifier des profils cliniques à risque de comportements violents (CV), dans la phase précoce de psychose, sur la base des principaux facteurs de risque psychopathologiques dynamiques et décrire les particularités des groupes qui présentent le plus haut taux de CV.MéthodeSur une cohorte prospective de 265 patients recrutés au sein du programme de traitement et d’intervention précoce des troubles psychotiques (TIPP–Lausanne), nous avons conduit des analyses de classes latentes et une analyse discriminante sur les facteurs de risque dynamiques de CV (abus de substance, impulsivité, symptômes positifs, insight, agressivité, hostilité, colère, instabilité affective et adhésion au traitement). Les CV ont été évalués par des case-managers, par des informations provenant des services forensiques et par l’intermédiaire d’un relevé durant les hospitalisations.RésultatsQuatre groupes hétérogènes se dégagent, dont deux groupes avec des taux de CV élevés : le premier se distingue par la prévalence d’un ensemble de dimensions relatives à l’hostilité, l’impulsivité et l’instabilité affective, de hauts niveaux d’abus de substances et de symptômes positifs. Le second par un manque d’insight, d’adhésion au traitement et une consommation de substances. Ces deux profils pourraient majorer l’altération des capacités cognitives, fonctionnelles et relationnelles et contribuer à l’apparition de CV dans cette phase précoce de psychose.ConclusionIl est possible d’identifier des groupes à risque de CV au cours de la première phase de psychose, sur la base de caractéristiques cliniques susceptibles d’évoluer et donc d’être l’objet de prises en charge à visée préventive.

Violence in correctional facilities is an important issue for both prisoners and prison staff. Risk assessment instruments have demonstrated their accuracy in predicting the risk of (re) offending and institutional violence in psychiatric settings, but less is known about their ability to predict violent misconduct in prison. The present study applied four risk assessment instruments (Structured Assessment of Protective Factors for violence risk, Historical Clinical Risk Management-20, Psychopathy checklist - Revised, and Violent Risk Appraisal Guide) to 52 violent offenders in a Swiss prison in order to evaluate the instruments' predictive validities. Outcomes were instances of physically violent, other and any misconduct as recorded in prison files during the 12 months following the prisoners' assessments. Approximately 15% of offenders committed physically violent misconduct and approximately 42% committed any misconduct. The results show that mainly dynamic assessment tools are as good predictors of physically violent misconduct as mainly static assessment tools. Targeting dynamic factors could increase the effectiveness of interventions to reduce the risk of physical violence in prison.

OBJECTIVE:This study aims to determine whether it is possible to identify clinical profiles at risk of violent behaviors (VB) in the early phase of psychotic disorders, on the basis of the main dynamic psychopathological risk factors and describe characteristics of the groups with highest levels of violent behaviors. METHOD:A total of 265 patients, aged 18 to 35, treated at the Treatment and early Intervention in Psychosis Program (TIPP-Lausanne), a specialized early psychosis program, were included in this study. We conducted a latent-class analysis and a discriminative analysis on the basis of the main dynamic VB risk factors: substance use disorder, impulsivity, positive symptoms, insight, aggression, hostility, anger, emotional instability and adherence to treatment. These factors were evaluated by specialized scales and on the basis of the Positive and Negative Syndrome Scale (PANSS). VB were restricted to physical aggression against people, defined as "serious violence". They were assessed on the basis of a questionnaire listing violent offenses (Swiss Criminal Code) and VB such as assault and battery, information through the forensic psychiatric services and on the basis of the Staff Observation Aggression Scale (SOAS-R scale) during inpatient treatment phase. RESULTS:Four heterogeneous subgroups were identified with respect to the studied clinical characteristics, including two groups with high rates of VB. The first group, comprising 46% of patients with VB, is distinguished by the prevalence of a range of dimensions related to hostility, impulsivity and emotional instability, associated with high levels of substance abuse and positive symptoms. These clinical dimensions are very significant at the statistical level, since they explain 70% of the construction of subgroups (discriminant analysis). The second group with 37% of patients with VB, is characterized by a lack of insight, lack of adherence to treatment and substance use. These two clinical profiles could increase the impairment of cognitive, functional and relational abilities and contribute to the development of VB in this early phase of psychosis. The third subgroup, with a violent behaviors rate of 28.6%, is distinguished by its high proportion of diagnoses of substance abuse (100%) and women (54%). A last subgroup of patients, the largest quantitatively, has a low proportion of VB (15%) and the lowest levels on the studied factors, suggesting that the majority of patients with this profile commit few VB. CONCLUSION:Our results show that it is possible to identify groups at risk of violent behaviors during the early phase of psychosis on the basis of clinical characteristics that may evolve and therefore be the focus of preventive care. These results highlight the need to target substance use, impulsivity and lack of insight at follow-up in order to prevent VB.

BACKGROUND:Substance-use disorder (SUD) was found to be an aggravating factor to delinquency and is closely related to personality disorders (PDs).OBJECTIVES:The aim of this study was to investigate sex differences in the relationship between PD traits and SUD in adolescents institutionalized in child welfare and juvenile justice institutions.METHODS:PD traits were measured dimensionally in a sample of 282 boys (69 with an SUD diagnosis) and 143 girls (45 with an SUD diagnosis) from child welfare and juvenile-justice institutions.RESULTS:Logistic regressions showed that antisocial, borderline, and paranoid personality traits were positively associated with SUD, while obsessive compulsive personality traits were negatively related with SUD. Additionally, in institutionalized girls, self-defeating personality traits were associated with less risk of SUD.CONCLUSION:This study provides a relative evidence for sex specificities in the relation between PD traits and SUD.

AIM:Impulsive behaviours, which are frequent in young people suffering from psychosis have been linked to risky and violent behaviours and participate to the burden of psychotic illness. Given that morphological brain correlates of impulsivity in schizophrenia have been poorly investigated especially in young adults, the aim of this study was to investigate the relationship between impulsivity and cortical thickness in early psychosis (EP) patients.METHOD:A total of 17 male subjects in the early phase of psychosis were recruited. Impulsivity was assessed with the Lecrubier Impulsivity Rating Scale. Mean cortical thickness was extracted from magnetic resonance imaging brain scans, using surface-based methods.RESULTS:Mean cortical thickness in the frontal lobe correlated positively with mean impulsivity in EP male patients.CONCLUSION:Our results suggest that psychotic subjects exhibiting higher impulsivity have larger frontal cortical thickness, which may pave the way towards the identification of patients with a higher risk to display impulsive behaviours.

Background: Previous literature suggests that prevalence of cannabis use in the early phase of psychosis is high, and that early psychosis patients are at high-risk for violent behavior. However, the link between cannabis use and violent behavior in early psychosis patients is unclear. We carried out a study on a sample of early psychosis patients, in order to explore the impact of cannabis use on the risk of violent behavior (VB), while taking into account (1) potential confounding factors and, (2) interactions with other dynamic risk factors of VB. Method: In a sample of 265 early psychosis patients, treated at the Treatment and Early Intervention in Psychosis Program (TIPP) in Lausanne, we used logistic regression models to explore the link between various dynamic risk factors of VB [positive symptoms, substance use disorder (drugs including cannabis, alcohol and others drugs), insight, impulsivity, affective instability, and treatment adherence], and VB occurring during treatment. In order to understand hierarchical effects attributable to the combinations of risk factors on VB we conducted a Classification and Regression Tree (CART). Results: Our results show that cannabis use disorder is a risk factor for VB. The associations among risk factors suggest the presence of two patient profiles with an increased rate of VB: the first is composed of patients with cannabis use disorder and impulsivity, and the second of patients combining cannabis use disorder, absence of insight and non-adherence to treatment. The results also show the moderating role of insight and adherence to treatment on the rate of VB in patients with cannabis use disorder. Conclusion: This study suggests that cannabis use disorder is a significant risk factor for VB amongst early psychosis patients, particularly when combined with either impulsivity, lack of insight and non-adherence to treatment. These results suggest that preventive strategies could be developed on the basis of such patient profiles.

BACKGROUND:Violent behaviour (VB) occurs in first episode of schizophrenia and can have devastating impact both on victims and patients themselves. A better knowledge of the underlying mechanisms of VB may pave the way to preventive treatments.OBJECTIVES:1) To explore the nature of the link between impulsivity and VB in early psychosis (EP) patients; 2) To explore the interactions between impulsivity and substance abuse, insight, and positive symptoms, the main dynamic risk factors of VB described to date.DESIGN AND METHODS:Post hoc analysis of data acquired in the frame of a 36-months EP cohort study. A total of 265 EP patients, aged 18 to 35, treated at TIPP (Treatment and early Intervention in Psychosis Program), at the Department of Psychiatry in Lausanne, Switzerland, were included in the study. Logistic regression analyzes were performed as well as mediation analysis and interaction analysis RESULTS: Our data suggest that impulsivity is a predictor of VB when analyzed independently and as part of a multi-factorial model. Impulsivity continues to differentiate violent patients from non-violent ones at the end of the program. In addition, the relationship between impulsivity and VB is not mediated by substance abuse. Finally, the effect of impulsivity on the probability of VB is potentiated by the interaction of different levels of insight and positive symptoms.CONCLUSIONS:Early intervention strategies in psychotic disorders should include evaluation of impulsivity considering it is linked to increased risk of VB and may respond to treatment.

Background The present study investigates the possibilities of using heart rate variability (HRV) parameters as physiological markers that precede increase in observed behavioral excitation of intellectually disabled individuals. The ability to recognize or predict such patterns, especially in patients showing unpredictable reactions and language deficiencies, might be a major step forward in clinical research. Method Thirteen volunteers with intellectual disabilities, who had suffered of at least one event of overt aggression in the preceding 3 months, participated to the study. The protocol consists in the acquisition of continuous electrocardiogram (ECG) throughout approximately two times of 8 h in natural situation, using a T-shirt integrated with sensors. Simultaneously, an observer evaluates the patient’s level of overt excitation from calm (level 1) to extremely tense (level 5) and send online via Bluetooth these triggers into the ECG signals. The HRV indexes were then estimated offline on the basis of the inter-beat intervals recorded by the ECG, independently for the 30 min preceding each behavioral tension marking point, averaged, and compared through non-parametric Wilcoxon matched-pairs test. Of these, the RMSSD and LF/HF calculations were used to observe the fluctuations of inhibitory activity and cardiovagal balance through different tension states. Results Seven individuals have sufficient reliable data for analysis. They have reached at least a level 3 of behavioral excitation (moderately tense) or more (very to extremely tense, level 4 and 5) and have been retained for further analysis. In sum, a total of 197 periods of tension were kept, made up of 46 periods of slight excitation (level 2), 18 of moderate excitation (level 3), 10 of high excitation (level 4), and 5 of extreme agitation (level 5). Variations in the HRV as a function of degree of excitation are observed for RMSSD index only (inhibitory parasympathetic activity). The changes from calm to increasing levels of excitation are characterized by a significant downfall in RMSSD index when patients were evaluated to be in a very high level of tension (level 4). Conclusion The presence of precursors to agitation, reflected in the falling-off of parasympathetic activity, offers potentially interesting prospects for therapeutic development.