BackgroundPoor self-control is a strong correlate of criminal propensity. It is conceptualized and operationalized differently in criminology than in other scientific traditions.Aims(1) To verify the dimensionality of the criminological Grasmick self-control items, other self-regulation items and morality ones. (2) To re-interpret the dimensions using a clinical perspective, a taxonomic/diagnostic model and references to possible “biological underpinnings.” (3) Validate the dimensions by associations with crime.MethodPopulation: all persons born 1995 in Malmö and living there at age 12. A random sample (N = 525) filled in a comprehensive self-report questionnaire on themes like personality, crime/abuse and social aspects at age 15, 16 and 18. Age 18 data were analysed: 191 men and 220 women.ResultsSelf-regulation items were 4-dimensional: ADHD problems (Behavior control and Executive skills) and two Aggression factors. Morality items formed a fifth dimension. Negative Affect and Social interaction factors covered the rest of the variance. The validity of these factors was backed up by correlations with similar items/factors. Self-regulation subscales predicted crimes better than the Grasmick scale; an interaction with morality improved prediction still further. Sex differences were over-all small with three exceptions: Aggression, Morality and Negative affect.ConclusionWe identified four dimensions of the 20-item Grasmick instrument: Cognitive action control (impulsiveness/sensation seeking, response inhibition), Executive skills/future orientation, Affective/aggression reactivity and Aggression control. All should be possible to link to brain functional modules. Much can be gained if we are able to formulate an integrated model of self-regulation including distinct brain functional modules, process-and trait-oriented models, relevant diagnoses and clinical experiences of individual cases.

AbstractPractical work (craftsmanship) usually profits by science and vice versa, but conflicts may appear. Knowledge in empirical science is declarative and general. Practical knowledge is »silent« and reflects the cumulated individual experiences within a profession. In a mature discipline like medicine, recognition of the unique value of the two kinds of knowledge protects against conflict. The police have only recently added science to govern practice. In addition, much of the police work is rule-governed and politically controlled – it does not reflect empirical knowledge. Explanations in natural science refer to Causes in the objective world. Meaning is the corresponding humanities key concept which is also highly relevant for police work. When conflicts arise – a dominant discourse may warp discussions. Examples of a set of such relevant conflicts are provided and discussed. Awareness and acknowledgement of the virtues and limitations of various knowledge forms are often lacking and leads to mutual disrespect. Such conflicts are currently difficult to resolve because the police leadership usually lacks practical police experience as well as training in empirical science. The presently weak voice of science should be strengthened by a full academization of the police in all Nordic countries.

Intimate partner violence (IPV) is a global health problem with severe consequences. One way to prevent repeat IPV is to identify the offender's risk of recidivism by conducting a risk assessment and then implement interventions to reduce the risk. In order to be effective, accurate risk assessments and effective interventions are required. Practitioners in different settings are conducting IPV risk assessments, but the predictive validity of practitioners' IPV assessments has not been studied via a comprehensive literature search. This is the overall aim of the present study. The literature search was conducted in five different databases and at three different publisher sites. The selection of studies was based on nine different inclusion and exclusion criteria. The number of studies that fulfilled the criteria was unexpectedly small (N = 11). One of the studies was conducted in a treatment setting, the others in criminal justice settings. The predictive accuracy for the global risk assessments ranged from low to medium. The role of treatment or other interventions to prevent repeat IPV had been analyzed in one way or another in eight of the studies. There is a knowledge gap, the reasons of which are discussed.

Objective: The evidence for central stimulant (CS) treatment in ADHD is strong in some respects but not with respect to unselected clinical material and long-term effects over the life course cycle. The objective of this study was to explore differences in vocational, psychiatric, and social impairment, including crime and substance abuse, among adults with ADHD, treated or not, with CS drugs before age 18. Method: A clinical population of men (N = 343) and women (N = 129) seeking CS treatment as adults was assessed within a specific program for such treatment. Clinical information and data collected by structured instruments were available. Results: Previously CS-treated persons had a lower frequency of problems (alcohol/substance abuse, criminality), and of certain psychiatric disorders (depressive, anxiety and personality ones). Most differences were substantial. Conclusion: The study supports the assumption that CS treatment during childhood/adolescence offers some protection against the development of a range of problems known to characterize adult ADHD patients.

OBJECTIVE:The de-institutionalizing process came to an end before the millennium shift by closing mental hospitals. After that some of the most ill patients are cared for in sheltered housing (SH). There is no in-house psychiatric competence and the staff on the floor usually lacks such knowledge and training. Observation instruments may improve this by making it possible to assess and monitor patients.METHOD:FAST-O is a simple twelve-item observation scale. Staff at eight SH units were trained in using the instrument and then assessed a total of 67 patients once, twice or three times at monthly intervals.RESULTS:Ten items formed two highly homogenous subscales reflecting Social skills (Soc) and Excitation/Aggression (E/A). Depression and Clinical Global Impression (CGI) items were considered separately. The correlation pattern suggested that the ratings had construct validity. A cluster analysis identified three patient subgroups, of which one had very high E/A scores. Comparisons with reference data suggested that the average symptom level was on par with acutely admitted in-patients for this subgroup. In all groups, E/A symptoms varied considerably over time, the other symptoms were more stable. There were marked differences among the eight SH units with respect to the level of patient problems.CONCLUSIONS:The SH staff was able to produce valid FAST-O assessments. There are reference data which makes it possible to characterize individual patients as well as SH units with respect to treatment needs and safety aspects (for instance risk of violence).

Risk assessment tools are increasingly being used to guide decisions about supervision and treatment of domestic violence perpetrators. However, earlier review studies showed that the predictive validity of most of these tools is limited, and is reflected in small average effect sizes. The present study aimed to meta-analytically examine the predictive validity of domestic violence risk assessment tools, and to identify tool characteristics that positively moderate the predictive validity. A literature search yielded 50 independent studies (N = 68,855) examining the predictive validity of 39 different tools, of which 205 effect sizes could be extracted. Overall, a significant discriminative accuracy was found (AUC = 0.647), indicating a moderate predictive accuracy. Tools specifically developed for assessing the risk of domestic violence performed as well as risk predictions based on victim ratings and tools designed for predicting general/violent criminal recidivism. Actuarial instruments (AUC = 0.657) outperformed Structured Clinical Judgment (SCJ) tools (AUC = 0.580) in predicting domestic violence. The onset of domestic violence (AUC = 0.744) could be better predicted than recurrence of domestic violence (AUC = 0.643), which is a promising finding for early detection and prevention of domestic violence. Suggestions for the improvement of risk assessment strategies are presented.

Morality is back in criminological research. We designed a moral dilemma questionnaire and studied to which extent the instrument differentiated socially well-adjusted persons from criminals. If so, are criminals able to “fake good”, which would make the instrument useless except in a research context with anonymous participants.

Abstract Risk assessments are used by the police in order to identify the need for victim protection. The aim of this study was to examine the inter-rater reliability of two violence risk assessment tools; the Police Screening Tool for Violent Crimes (PST-VC) and the Brief Spousal Assault Form for the Evaluation of Risk (B-SAFER), used by police employees in two different police authorities in Sweden. The inter-rater agreement was evaluated for both tools, with respect to global risk assessments, recommended protective actions and risk- and victim vulnerability factors. The main results showed that the inter-rater agreement was highest for the global assessments and widely varying, from very low to fairly high, for the structured variables. The fairly high reliability for the global risk assessments was most likely due to shared assumptions (heuristics, tacit knowledge) among the assessors rather than being based on the information obtained by the tools.

DSM-III defined an Aggressive subtype of Conduct disoder; removed from later DSM-versions.The aim of this study was to analyse correlates of aggression and its predictive power from childhood up to age 57 in very advanced juvenile delinquents.80 boys entered the study 1975-76 while being cared for in a national (last resort) Juvenile Correction (JC) school.All boys had serious behavioural problems with onset before age 12. Scores on a 4-point Childhood Aggression Behaviour (CAB) scale were bimodal.Aggression was retrospectively associated with poor socio-economic conditions and school problems, predicted violent crimes and discipline problems during JC, and violent crimes but not other crimes or social outcome in adulthood (at age 30).Mortality was high, Relative Risk was 8 at age 30 and 44% were dead at age 57 (20 lost years of life).The predictive power of CAB for future crimes of violence suggests that the Aggressive subtype of DSM-III CD maybe should be reintroduced.

Background: Externalizing symptoms in children (aggression, oppositionality, property and status violations), and the Attention Deficit Hyperactivity Disorder (ADHD) triad of problems (inattention, hyperactivity, impulsivity) display a substantial co-morbidity. The “short temper” problem is common to these syndromes, which are predictive of a range of negative life outcomes including substance abuse and criminality in adulthood. There is a gender gap for the syndromes (boys are more affected), for criminality (men are more criminal) and knowledge (we know less about girls’ criminal careers). Aims: The main aim was to compare crime rates and crime profiles among former Child and Adolescent Psychiatric (CAP) patients with corresponding data for matched controls, focusing externalizing and internalizing psychiatric symptoms, sex and adverse social factors. Method: Data for 6055 former CAP-Stockholm outpatients were extracted from available treatment registers. For each CAP patient, two matched controls from the general population were randomly selected from the same area of residence, of the same sex and with the same year of birth (N approx. 12,000). Data on criminality for these individuals were obtained from a Swedish police register which also includes crimes committed prior to age 15. Results: Overall, twice as many former CAP patients were registered for crimes at a mean age of 21.4 compared to the controls. The over-representation was larger for crimes of violence. Females were registered for a much lower number of crimes, particularly crimes of violence (gender gap). The gender gap among the CAP patients was smaller than among controls. Compared with controls, CAP patients characterized by externalizing problems at referral had an odds ratio (OR) for crimes of 5 for males and 10 for females. Neglect was the only adverse social factor which was associated with a higher crime rate and affected boys more than girls. Compared to previous Swedish CAP cohorts, the criminality of the current cohort was much higher. Conclusion: In-depth studies of female crime careers characterized by externalising problems are needed. Child psychiatric services must find new and more effective ways of identifying and treating children with such problems, regardless of sex. The findings can guide the choice of strategies which will reduce crime rate.

Abstract Relapse into intimate partner violence (IPV) can potentially be predicted and counter-measures applied. This study examines the predictive validity of a violence risk assessment tool: the Police Screening Tool for Violent Crimes (PST-VC) among a sample of 65 offenders. All PST-VC assessments regarding IPV that were conducted at the Scania police department in 2010 were included in the sample. Follow-up time was 16–28 months, and all reported incidents with the same victim and suspected offender were recorded. The PST-VC demonstrated limited effect in the ability to identify high-risk offenders and predict repeat victimization. Interventions against the offender and victim protective actions were more often recommended in high-risk cases but did not lower the number of IPV relapses. The study suggests that the PST-VC is not a promising instrument.

OBJECTIVE:To investigate the effect of second-generation antipsychotics on cognitive function in patients diagnosed with schizophrenia or schizoaffective disorder.METHOD:Multiple-treatments meta-analysis model.RESULTS:On cognitive composite score, sertindole was superior to clozapine, effect size (ES) 0.87; 95% CI: 0.12-1.63, quetiapine, ES 0.75; 95% CI: 0.00-1.49, and first-generation antipsychotics (FGAs), ES 0.89; 95% CI: 0.14-1.64. Analyses on each cognitive domain showed clozapine, ES 0.37; 95% CI: 0.00-0.74, olanzapine, ES 0.31; 95%CI: 0.02-0.59, quetiapine, ES 0.34; 95% CI: 0.03-0.64, and FGAs, ES 0.51; 95% CI: 0.18-0.83 performing poorer on verbal working memory than ziprasidone, as well as FGAs performing poorer than risperidone, ES 0.31; 95% CI: 0.04-0.58. On executive function, sertindole performed better than clozapine, ES 0.82; 95% CI: 0.06-1.58, olanzapine, ES 0.81; 95% CI: 0.07-1.55, quetiapine, ES 0.76; 95% CI: 0.02-1.51, ziprasidone, ES 0.90; 95% CI: 0.14-1.67, and FGAs, ES 0.83; 95% CI: 0.08-1.58. On processing speed, FGAs performed poorer than sertindole, ES 0.97; 95% CI: 0.02-1.91, and quetiapine, ES 0.36; 95% CI: 0.01-0.72. On long-term verbal working memory, clozapine performed poorer than olanzapine, ES 0.41; 95% CI: 0.06-0.76. On verbal fluency, FGAs performed poorer than olanzapine, ES 0.26; 95% CI: 0.01-0.50, and clozapine, ES 0.44; 95% CI: 0.06-0.81. Lastly, FGAs, ES 0.41; 95% CI: 0.04-0.78, and clozapine, ES 0.44; 95% CI: 0.05-0.83, performed poorer on visuospatial skill compared to olanzapine.CONCLUSION:The meta-analysis was able to detect some trends in the data analyzed, but did not show any drug having a uniform positive cognitive profile.

Foreliggande rapport presenterar resultatet fran en utvarderingsstudie av polisens arbete med riskbedomning och riskhantering (samlingsnamn riskanalys) utifran riskbedomningsverktyget SARA:SV som anvands for att bedoma risken for upprepat vald i nara relationer pa individniva. Materialet som analyserats omfattar 320 arenden som efter initial bedomning blev foremal for SARA:SV-bedomning av riskanalytiker vid Polismyndigheten i Uppsala under aren 2011 och 2012. Fokus for utvarderingen ar resultatet av de riskanalyser som genomforts, inte arbetets organisering, aven om den aspekten berors. Verktyget har framst utvarderats avseende internt bortfall, prediktiv validitet, rekommenderade och genomforda stod- och skyddsatgarder samt interbedomarreliabilitet. Resultaten visar att det interna bortfallet for riskfaktorerna varierar mellan drygt fyra procent for faktorn tidigare vald (aktuell situation) och 53 % for faktorn psykiska problem (bakgrund). Variationerna mellan variablerna ar stora men bortfallet ar systematiskt lagre for riskfaktorerna rorande garningspersonens bakgrund (4-39 %) jamfort med faktorerna som ror garningspersonens psykosociala situation (10-53 %). Jamfort med liknande studier ar bortfallet hogt. I praktiken innebar det stora interna bortfallet att ett alltfor stort antal bedomningar baseras pa otillracklig information om garningsperson och brottsoffer. Detta leder till att validiteten inte kan garanteras eftersom bedomningen av risken inte bygger pa den information som kravs for att bedoma risken. Ju hogre bedomd risk, bade for bedomning av sannolikhet och allvarlighetsgrad i aktuell situation och bakgrund, desto fler var de foreliggande riskfaktorerna. En dryg tredjedel av hela undersokningsgruppen blir upprepat utsatta for nagot brott. I flertalet fall ar alltsa de atgarder som satts in inte tillrackliga for att forhindra ytterligare brott. Vi noterar ocksa att kategorin lag/viss risk ar storst, att bedomarna inte anvander hela bedomningsskalan samt att aterfallen ar vanligare i arenden som inte bedomts med hog risk. En stor andel av de upprepade brotten begicks kort tid efter bedomningen. Detta innebar sammantaget att verktyget SARA:SV har lag grad av prediktiv validitet i foreliggande studie och fungerar daligt for att inom polisverksamhet predicera aterfall i brott i foreliggande studie (dvs. diskriminera mellan grupperna aterfall/ej aterfall) eftersom antalet korrekta forutsagelser endast ar ungefar 7 av 50. Den vanligaste rekommenderade atgarden ar kontaktforbud (en dryg fjardedel av fallen) och information om brottsofferstodjande verksamheter i ungefar lika manga fall. Sakerhetssamtal och sakerhetsbesiktning rekommenderas i drygt 20 % av arendena. Ovriga atgarder an dessa forekommer sallan. Totalt rekommenderades 355 atgarder. I 42 % av arendena rekommenderades inga atgarder, i 30 % en atgard, i 10 % tva eller tre atgarder och i ett litet antal fall (farre an 5 %) fyra eller maxantalet fem atgarder. Samtliga atgarder rekommenderas i storre utstrackning an de genomfors. Kontaktforbud beviljas av aklagare endast i knappt halften av de fall dar de rekommenderas av den som gor riskbedomningen. Interbedommarreliabiliteten ar god for de sammanfattande bedomningarna men detta ar skenbart. Samstammigheten uppkommer genom den magkansla som ar gemensam for bedomarna: polisutbildningen, gemensamma erfarenheter, poliskulturen och lokala kulturer (t.ex. bland polisanstallda som arbetar med riskbedomningar). Tittar vi pa hur tva bedomare motiverar att de bedomde ett visst fall pa ett visst satt (utifran svaren pa huruvida de enskilda faktorerna foreligger helt eller delvis eller inte foreligger) ar dessa helt olika. Eftersom man ar osaker pa sin bedomning haller man sig i mitten av bedomningsskalorna. Man anvander sig i huvudsak av tva (av fem) skalsteg for den sammanfattande bedomningen. Ytterst syftar riskbedomning och riskhantering i detta sammanhang till att forhindra aterfall och upprepad viktimisering av brottsoffren. Var undersokning kan inte ge nagra definitiva svar pa om detta syfte uppfylls. Detta med anledning av att det ar omojligt att med strikt vetenskaplig metod studera huruvida riskbedomning forhindrar brott. Detta ar ett problem som vidhaftar alla studier inom omradet. Vi kan inte identifiera en risk och sedan inte gora nagot at den. Det gar inte att slumpa riskbedomningen, dvs. singla slant om en viss garningsperson har hog eller lag risk och sedan agera utifran detta nar atgarder vidtas. Kortfattat visar utvarderingen att bortfallet ar stort och att vissa faktorer, sarskilt de personlighetsmassiga faktorerna, ar svara att bedoma, och att riskbedomning i sig ar ett svart uppdrag som utan ratt implementering och utbildning blir mycket svart att lyckas med. Dessutom ar evidensbasen for den preventiva formagan hos de atgarder som finns tillgangliga svag.

Strong self-esteem is related to good psychological health. Dyslexia has a negative effect on self-esteem, but this effect depends on support levels at home and/or school. Women with dyslexia are an under investigated group, and it has been suggested that female dyslexics should be given special attention from teachers with a view to improving their self-esteem. This paper set out to compare levels of self-esteem in women with dyslexia and normative women, and to investigate relationships between dyslexic problems and self-esteem. It was hypothesized that women with dyslexia would have a weaker self-esteem. We have assessed dyslexia, using a Swedish battery of standardised pedagogical, IQ, and neuropsychological tests, and the self-esteem of twelve young women (mean age 19 years; range 16-30), using a Swedish questionnaire that distinguishes between different dimensions of self-esteem (physical characteristics, talents and gifts, psychological health, relationships with parents and family, and relationships with others). Comparative (t-tests) and correlational (Pearson’s correlations and stepwise multiple regression analyses) statistical methods were performed. The study subjects had a weaker self-esteem than that of a normative sample of females (N = 313) in all dimensions, except for the dimension of relationships with parents and family. Spelling ability was related to “Physical characteristics” (negative) and to “Relations with parents and family” (positive). Moreover, speed of reading was related to “Psychological health” (positive). The use of questionnaires that distinguish between different dimensions of self-esteem and a larger sample is recommended in future studies.

De olika verktyg for riskbedomning av upprepat vald pa individniva som anvands inom svensk polis idag och hur de fungerar i rutinverksamhet har hittills utvarderats i begransad utstrackning. I foreliggande rapport sammanfattas resultat fran fyra studier i vilka verktygen Check-10(+), SARA:SV och Skanemodellen har utvarderats (Mellgren m.fl ., 2012; 2014a; 2014b; Svalin m.fl ., 2014). Samtliga verktyg bygger pa kunskap om riskfaktorer for de olika brottstyper for vilka aterfallsrisken ska bedomas och stod- och skyddsatgarder sattas in. Den mesta kunskapen kommer dock fran andra verksamheter an polisverksamhet. Foljande fragor diskuteras i rapporten: *Vilka ar de arenden som blir foremal for strukturerad bedomning och hur fungerar den initiala bedomningen som sorteringsgrund? * Bidrar processen med riskanalys till minskad upprepad utsatthet? * Kan riskanalys anses fungera val i polisverksamhet? Den initiala bedomningen ar det forsta steget i riskanalysens process. Om den inte fungerar ar sannolikheten storre att inte heller den strukturerade bedomningen i steg tva fungerar. Genomgangen av de arenden som blir foremal for riskanalys med Skanemodellen, Check-10(+) och SARA:SV visar att fa av alla de arenden som anmals under ett ar bedoms strukturerat. Av dem ar det endast ett fatal dar det bedoms foreligga sarskilt forhojd risk, de fl esta bedoms som lag eller medelhog risk. For att vidare svara pa fragan om de mest allvarliga arendena blir bedomda bor en uppfoljning goras for ett urval av de arenden som inte gar vidare till strukturerad bedomning for att kunna jamfora aterfallsfrekvensen med och utan bedomning och tillhorande stod- och skyddsatgarder. For samtliga undersokta verktyg och de bedomningar som genomforts utifran dessa ar det interna bortfallet stort for vissa faktorer, sarskilt for de som ror garningspersonens psykiska halsa. * Detta innebar i praktiken att bedomningar av risk gors utan ett komplett underlag. Det i sin tur innebar att den traffsakerhet man haft i de vetenskapliga studierna av verktygen inom andra verksamheter inte gar att uppna i polisens vardagsarbete. Forlusten i traffsakerhet kan vara sa stor att bedomningen narmar sig slumpnivan. Da ar det meningslost att alls gora riskbedomningar. * Verktygen visar lag prediktiv validitet, andelen upprepat utsatta bland arenden som bedomts med Skanemodellen och SARA:SV ar stor, till- gangen till atgarder ar begransad och atgardernas preventiva formaga forefaller vara svag och kan i vissa fall antagligen oka brottsrisken. Riskbedomningarna kan vara mycket bra men om de atgarder som vidtas pa basen av riskbedomningar och ekonomiska kalkyler inte har nagon effekt, t.ex. en viss brottspreventiv atgard som enligt kriminologisk forskning inte fungerar brottspreventivt pa en viss grupp av kriminella – da ar vinsterna med verksamheten sma. Nar de forsta moderna riskbedomningsmetoderna lanserades i mitten av 1990-talet fokuserade man ute slutande pa riskbedomningen – inte vad som skulle goras utifran den. I dag ar riskbedomningar av detta slag alltid sammankopplade med riskhanteringsatgarder. Om ambitionen ar att basera denna typ av verksamhet pa vetenskap racker det inte att utvardera om riskbedomningarna ar tillrackligt bra – vi maste ocksa utvardera effekten av de atgarder som styrs av riskbedomningen. Mot bakgrund av detta ar en av de viktigaste slutsatserna – och rekommendationerna – att kunskapen om hur verktygen fungerar maste oka innan rekommendationer gors. Sammanfattningsvis, leder riskanalys till minskad upprepad utsatthet for brott och kan verktygen anses fungera val i svensk polisverksamhet? Ett kortfattat svar pa fragan ar: Nej, inte baserat pa de utvarderingar som genomforts inom detta projekt. Kunskapen om vilka arenden som inte bedoms ar begransad och vi vet inte om ”ratt” arenden gar vidare. Baserat pa att fl est arenden bedoms som lag eller medelhog risk ar en rimlig slutsats att manga hogriskarenden missas. Bortfallet ar ibland sa hogt att bedomningens validitet maste ifragasattas, dvs. man mater inte det man avser att mata och en bedomning baserad pa bristfallig information riskerar att bli felaktig. Detta bekraftas av att traffsakerheten ar lag och andelen upprepat utsatta hog. I tillagg ar interbedomarreliabiliteten i vissa avseenden lag, bade for Skanemodellen och for SARA:SV. En kritisk faktor ar det forsta steget i riskbedomningen (screening), dvs. procedurerna for att valja ut ett begransat antal av alla inkommande arenden, som sedan gar vidare till en strukturerad riskbedomning. Det bor vara mojligt att skapa valfungerande screening-rutiner pa basen av redan kanda sakforhallanden och befi ntliga databaser, dvs. aktuariska riskfaktorer som ar omedelbart tillgangliga for polisen vid screeningen. Sadana riskfaktorer ar alder, kon, tidigare kriminalitet i allmanhet och valdskriminalitet i synnerhet, offer (narstaende och/eller andra), brottsbredd (manga olika typer av tidigare brott), varddomar och indikatorer pa missbruk. Polismyndigheten bor genomfora storre utbildnings- och implementeringsinsatser samt folja upp, utvardera och anpassa arbetet med riskbedomning av vald pa individniva. Darefter bor nationella verktyg rekommenderas och riktlinjer for arbetet tas fram. Detta kraver resurser, men menar man allvar med satsningen pa riskbedomningar ar detta nodvandigt. Punktinsatsernas tid bor vara forbi och det langsiktiga forbattringsarbetet inledas omgaende.

Background: Patients diagnosed with schizophrenia display poor premorbid adjustment (PPA) in half of the cases. Attention deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) are common child psychiatric disorders. These two facts have not previously been linked in the literature. Aims: To determine the prevalence of ADHD/CD problems retrospectively among patients with psychoses, and whether and to what extent the high frequency of substance abuse problems among such patients may be linked to ADHD/CD problems. Method: ADHD and CD problems/diagnoses were retrospectively recorded in one forensic (n = 149) and two non-forensic samples (n = 98 and n = 231) of patients with a psychotic illness: schizophrenia, bipolar or other, excluding drug-induced psychoses. Results: ADHD and CD were much more common among the patients than in the general population-the odds ratio was estimated to be greater than 5. There was no significant difference in this respect between forensic and non-forensic patients. Substance abuse was common, but substantially more common among patients with premorbid ADHD/CD problems. Conclusions: Previous views regarding PPA among patients with a psychotic illness may reflect an association between childhood ADHD/CD and later psychosis. The nature of this association remains uncertain: two disorders sharing some generative mechanisms or one disorder with two main clinical manifestations. Childhood ADHD and particularly CD problems contribute to the high frequency of substance abuse in such groups.

Objective: To investigate the association between the Positive and Negative Syndrome Scale (PANSS) cognitive factors and cognition assessed by neuropsychological tests. Method: Ninety patients with a psychotic illness, the majority having a schizophrenia diagnosis, were assessed with PANSS ratings and tested by a comprehensive computerized neuropsychological test battery, EuCog. Results: Test performance was in the normal range for some of the cognitive indices, but substantially reduced for others, compared with norms, particularly speed-based indices. PANSS ratings were non-specifically associated with cognitive indices representing performance (speed and accuracy) and problem solving strategies (executive functions). There was no discriminant validity for the cognitive factor. A regression analysis suggested that the PANSS cognitive factors reflected verbal IQ but no other cognitive domain like memory, attention or speed. Conclusion: Cognitive test performance is associated with psychopathology as assessed by PANSS items but in a non-specific way. The PANSS cognitive subscale seems to reflect over-learned verbal skills rather than the cognitive domains, which are known to be specifically affected in schizophrenia and relevant for the prognosis. Consequently, PANSS ratings cannot replace the information inherent in neuropsychological test data. The extensive speed problem of patients with schizophrenia should be studied in more detail using test batteries that focus on that problem.

Socialstyrelsens rattsliga rad far, pa grund av en praxisgrundande dom i Hogsta domstolen, alltid ratt i domstolsprovningar. Detta ar inte en kvalitetsindikator, det talar for att nagot ar fel i systemet, anser Sten Levander.

The HCR-20 is widely used to assess risk of violence among patients with schizophrenia. Further understanding of the accuracy and changes over time in C and R scores is needed. Using prospectively collected data on 248 men with schizophrenia, the present study found that the HCR-20 significantly predicted aggressive behavior over 24 months. The H, C, R, HCR-20 total, and final risk judgment scores were unable to predict aggressive behavior better than chance among the general psychiatric patients in the first six months after discharge. Changes in three C items, the total R score, and in three R items significantly predicted changes in aggressive behavior.