Previous studies have shown that substance misuse in adolescence is associated with increased risks of hospitalizations for mental and physical disorders, convictions for crimes, poverty, and premature death from age 21 to 50. The present study examined 180 adolescent boys and girls who sought treatment for substance misuse in Sweden. The adolescents and their parents were assessed independently when the adolescents first contacted the clinic to diagnose mental disorders and collect information on maltreatment and antisocial behavior. Official criminal files were obtained. Five years later, 147 of the ex-clients again completed similar assessments. The objectives were (1) to document the prevalence of alcohol use disorders (AUD) and drug use disorders (DUD) in early adulthood; and (2) to identify family and individual factors measured in adolescence that predicted these disorders, after taking account of AUD and DUD in adolescence and treatment. Results showed that AUD, DUD, and AUDÂ +Â DUD present in mid-adolescence were in most cases also present in early adulthood. Prediction models detected no positive effect of treatment in limiting persistence of these disorders. Thus, treatment-as-usual provided by the only psychiatric service for adolescents with substance misuse in a large urban center in Sweden failed to prevent the persistence of substance misuse. Despite extensive clinical assessments of the ex-clients and their parents, few factors assessed in mid-adolescence were associated with substance misuse disorders 5Â years later. It may be that family and individual factors in early life promote the mental disorders that precede adolescent substance misuse.
Little is known about adult outcomes of males who as adolescents sought treatment for alcohol misuse or drug use, and who additionally were engaging or not engaging in other forms of delinquency. Since the rates of negative outcomes vary in the general population, the study determined whether the sub-groups of clinic attendees fared differently as compared to males of the same age who had not sought treatment for substance misuse from age 21 to 45. Adolescent males who consulted the only substance misuse clinic in a Swedish city between 1968 and 1971 were divided into four groups: ALCOHOL no drug use, no criminal offending (n=52); ALCOHOL+D no drug use, plus criminal offending (n=105); DRUG use, no criminal offending (n=92); and DRUG+D plus criminal offending (n=474). These four groups were compared to a general population sample (GP) of males matched on age and birthplace, who did not seek treatment for SM in adolescence. National Swedish registers provided data on death, hospitalizations for substance misuse (SM), mental and physical disorders, and criminal convictions. Compared to the GP, and after controlling for co-occurring adult outcomes, ALCOHOL showed elevated risks for SM hospitalization and convictions for violent crimes, and DRUG showed elevated risks for SM hospitalization, convictions for non-violent crimes, and hospitalization for psychosis. ALCOHOL+D and DRUG+D showed increased risk for SM hospitalization, violent and non-violent convictions, and DRUG+D additionally, for death, and hospitalizations for psychosis and physical illness. Misuse of alcohol without drug use or other delinquency in adolescence was associated with increased risk for convictions for violent crimes during the subsequent 25 years, in addition to SM, while adolescent drug use without other forms of delinquency was associated with increased risks for convictions for non-violent crimes, hospitalizations for SM, and non-affective psychosis. Cannabis use, with and without delinquency, was associated with subsequent hospitalization for non-affective psychosis. Consistent with contemporary studies, most adolescents treated for SM from 1968-1971 presented delinquency that was associated with an increase in risk of all adverse outcomes to age 45.
The association between psychotic symptoms and violence is unclear, due in part to methodological features of investigations that have examined this question, and in part to the fact that the association likely differs by disorder and treatment conditions. Using data from The Comparative Study of the Prevention of Crime and Violence by Mentally Ill Persons, we examined 128 men with schizophrenia or schizoaffective disorder discharged from general and forensic psychiatric hospitals in Canada, Finland, Germany, and Sweden. The association between symptoms and aggressive behavior was studied during two 6 month periods when the patients lived in the community. Severe positive and negative symptoms of psychosis, depression, and anxiety were measured at the beginning of each of the 6 month periods. In addition, at the beginning of the second 6 month period changes in symptoms in the previous period were indexed. Aggressive behavior was measured in each 6 month period by reports from patients and from collaterals. During the first 6 months post-discharge, after controlling for the presence of antisocial personality disorder or PCL score and past diagnoses of alcohol/drug abuse/dependence, the presence of a severe positive symptom significantly increased the risk of aggressive behavior. During the second 6 month period, after controlling for antisocial personality disorder or PCL score and self-reported alcohol/drug use, the presence of a severe positive symptom, a TCO symptom, and an increase in TCO symptoms significantly increased the risk of aggressive behavior. Neither depot medications nor obligatory community treatment reduced the risk of aggressive behavior after controlling for the presence of a severe positive symptom and/or TCO symptoms. These findings suggest that, among men with schizophrenia being treated in the community, the presence of severe psychotic symptoms and the development of TCO symptoms are antecedents of aggressive behavior.
about 50% of men with antisocial personality disorder (APD) present a comorbid anxiety disorder. Historically, it was thought that anxiety limited criminal activity and the development of APD, but recent evidence suggests that heightened responsiveness to threat may lead to persistent violent behaviour. Our study aimed to determine the prevalence of APD comorbid with anxiety disorders among offenders and the association of these comorbid disorders with violent offending.
a random sample of 495 male penitentiary inmates completed an interview using the Diagnostic Interview Schedule. After excluding men with psychotic disorders, 279 with APD were retained. All authorized access to their criminal records.
two-thirds of the prisoners with APD presented a lifetime anxiety disorder. Among them, one-half had the onset of their anxiety disorder before they were aged 16 years. Among the offenders with APD, those with, compared with those without, anxiety disorders presented significantly more symptoms of APD, were more likely to have begun their criminal careers before they were aged 15 years, to have diagnoses of alcohol and (or) drug abuse and (or) dependence, and to have experienced suicidal ideas and attempts. While there were no differences in the mean number of convictions for violent offences between APD prisoners with and without anxiety disorders, more of those with anxiety disorders had been convicted of serious crimes involving interpersonal violence.
among men with APD, a substantial subgroup present life-long anxiety disorders. This pattern of comorbidity may reflect a distinct mechanism underlying violent behaviour and signalling the need for specific treatments.
Childhood onset aggressive behavior is one of the most stable human characteristics. Previous literature indicates that this behavioral trait may be associated with body size. The present study investigated the association between body sizes at different ages and committing violent crimes in adulthood.
The Northern Finland 1966 Birth Cohort includes 5636 males followed up to age 31 years prospectively. Information on criminality was extracted from official records. Body sizes were measured at birth, 12 months and 14 years of age, and compared the violent and the non-violent offenders with the non-offenders. Optimal cut-off points for each of the body size measures for the differentiation of the three groups were identified. Odds ratios were adjusted taking account of maternal age, socioeconomic status of the family of origin, mother's marital status, parity, smoking during pregnancy, gestational age and unwanted pregnancy.
Both high body mass index (BMI) and small head circumference at 12 months were associated with increased risk of violent offending (adjusted ORs 1.6-1.8). High BMI at 12 months combined with small head circumference was associated with substantially increased risk of violent offending (OR 4.2, 95% CI 2.6-6.8).
In males, small head circumference and large body size at 12 months of age were strongly associated with an increased risk of violent, but not non-violent offending in adulthood. The measures at 12 months were the strongest predictors, suggesting that this association may be explained by genetic or early environmental factors, rather than social learning later in childhood and adolescence.
Men with schizophrenia are at increased risk, as compared to the general population, for criminal offending and to have displayed Conduct Disorder (CD) before age 15. The present study examined the consequences of CD among a sample of 248 men with schizophrenia or schizo-affective disorder, aged, on average, 39 years old. Participants were intensively assessed at discharge from the hospital and four times during the subsequent two-year period. CD was associated with criminality and substance misuse among first-degree male relatives and substance misuse among female relatives. In childhood and adolescence, CD was associated with poor academic performance, substance abuse, and physical abuse. In adulthood, the diagnosis of CD and each CD symptom were associated with increased non-violent and violent criminal offending, after adjusting for life-time diagnoses of substance misuse disorders. CD was not associated with homicide. CD was associated with life-time diagnoses of alcohol and drug abuse and/or dependence. During the 24 month follow-up period, CD and the number of CD symptoms were associated with aggressive behavior, controlling for life-time diagnoses of substance use disorders, substance misuse measured objectively and subjectively, medication compliance, and obligatory care. CD was associated with an earlier age at onset of schizophrenia and at first admission to hospital, and with length of time spent in hospital. During the two-year follow-up period, neither the diagnosis of CD nor the number of CD symptoms was associated with levels of positive and negative symptoms assessed five times, compliance with medication, substance use, or readmission. The results are interpreted to suggest that CD is a distinct co-morbid disorder that runs parallel to the course of schizophrenia.
Although they were once considered separate nosologic entities, there is current interest in the etiologic overlap between bipolar disorder (BD) and schizophrenia. A critical issue concerns the familial basis of the overlap, specifically, the possibility of a distinct familial subtype of BD with psychotic features.
We recruited individuals with BD from the community and compared them with a matched group diagnosed with no mental disorder to confirm familial aggregation for BD, schizophrenia, and psychotic symptoms. We then compared BD probands both with and without first-degree relatives with psychotic symptoms on several clinical indicators to determine the specificity of the familial aggregation.
As expected, there was evidence for familial aggregation of schizophrenia and psychotic symptoms in families having probands with BD. Familial loading for schizophrenia and psychotic symptoms was especially notable in male relatives of female probands with BD. We found no differences in the clinical profile of probands with BD stratified for familial loading for psychotic symptoms.
Findings from this sample support etiologic theories arguing for a shared but nonspecific genetic etiology for BD and schizophrenia, with psychotic symptoms being a potential key indicator for genetic studies.
Genotypes do not confer risk for delinquency but rather alter susceptibility to positive and negative environmental factors: gene-environmentinteractions of BDNF Val66Met, 5-HTTLPR, and MAOA-uVNTR [corrected].
Previous evidence of gene-by-environment interactions associated with emotional and behavioral disorders is contradictory. Differences in findings may result from variation in valence and dose of the environmental factor, and/or failure to take account of gene-by-gene interactions. The present study investigated interactions between the brain-derived neurotrophic factor gene (BDNF Val66Met), the serotonin transporter gene-linked polymorphic region (5-HTTLPR), the monoamine oxidase A (MAOA-uVNTR) polymorphisms, family conflict, sexual abuse, the quality of the child-parent relationship, and teenage delinquency.
In 2006, as part of the Survey of Adolescent Life in V?stmanland, Sweden, 1 337 high-school students, aged 17-18 years, anonymously completed questionnaires and provided saliva samples for DNA analyses.
Teenage delinquency was associated with two-, three-, and four-way interactions of each of the genotypes and the three environmental factors. Significant four-way interactions were found for BDNF Val66Met ? 5-HTTLPR?MAOA-uVNTR ? family conflicts and for BDNF Val66Met ? 5-HTTLPR?MAOA-uVNTR ? sexual abuse. Further, the two genotype combinations that differed the most in expression levels (BDNF Val66Met Val, 5-HTTLPR LL, MAOA-uVNTR LL [girls] and L [boys] vs BDNF Val66Met Val/Met, 5-HTTLPR S/LS, MAOA-uVNTR S/SS/LS) in interaction with family conflict and sexual abuse were associated with the highest delinquency scores. The genetic variants previously shown to confer vulnerability for delinquency (BDNF Val66Met Val/Met ? 5-HTTLPR S ? MAOA-uVNTR S) were associated with the lowest delinquency scores in interaction with a positive child-parent relationship.
Functional variants of the MAOA-uVNTR, 5-HTTLPR, and BDNF Val66Met, either alone or in interaction with each other, may be best conceptualized as modifying sensitivity to environmental factors that confer either risk or protection for teenage delinquency.
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Cites: Biol Psychiatry. 2014 Jan 1;75(1):2-324314060
Cites: Am J Psychiatry. 2011 Oct;168(10):1041-921890791
To examine associations of teacher-rated conduct problems (CP) and hurtful and uncaring behaviours (HUB) at age 6 and 10 with criminal convictions up to age 24 among 1593 males and 1423 females, and to determine whether aggressive behaviour at age 12 mediated the associations of CP and HUB with criminal convictions.
Teachers assessed HUB and CP at ages 6 and 10 and ratings above the 90th percentile at each age and within each sex were used to assign participants to 1 of 4 groups. Teachers assessed proactive, reactive, indirect, and verbal aggression at age 12. Juvenile and adult criminal records were obtained.
High CP and HUB males, aged 6, were 4 times more likely than males with lower ratings to acquire convictions for violent crimes and 5 times more likely to acquire convictions for nonviolent crimes by age 24. High HUB and CP females, aged 6, were 5 times more likely than females with lower ratings to have a conviction for a nonviolent offence by age 24. Among males, both aged 6 and 10, high HUB without CP were associated with elevations at risk of convictions for violent and nonviolent crimes, while among females the elevations at risk were limited to convictions for nonviolent crimes. Different types of aggressive behaviour mediated associations of high HUB and CP with subsequent criminal convictions, but not the association of HUB without CP and crime.
Teachers in elementary schools rated behaviours that, from age 6 onward, significantly predicted criminal convictions into early adulthood.
AIMS: To examine trajectories of resilience over 25 years among individuals who as adolescents received treatment for substance misuse, the clinical sample (CS) and a matched general population sample (GP). DESIGN: Comparison of the CS and GP over 25 years using Swedish national registers of health care and criminality. SETTING: A substance misuse clinic for adolescents in an urban area in Sweden. MEASUREMENTS: Resilience was defined as the absence of substance misuse, hospitalizations for physical illnesses related to substance misuse, hospitalization for mental illness and law-abiding behaviour from ages 21 to 45 years. PARTICIPANTS: The CS included 701 individuals who as adolescents had consulted a clinic for substance misuse. The GP included 731 individuals selected randomly from the Swedish population and matched for age, sex and birthplace. FINDINGS: A total of 52.4% of the GP and 24.4% of the CS achieved resilience in all domains through 25 years. Among the CS, another one-third initially displayed moderate levels of resilience that rose to high levels over time, one-quarter displayed decreasing levels of resilience over time, while 9.3% showed little but improving resilience and 8.8% showed no resilience. Levels of resilience were associated with the severity of substance misuse and delinquency in adolescence. CONCLUSIONS: Individuals who had presented substance misuse problems in adolescence were less likely to achieve resilience over the subsequent 25 years than was a matched general population sample, and among them, four distinct trajectories of resilience were identified. The severity and type of problems presented in adolescence distinguished the four trajectories.