Clinical aspects of behavioral dysregulation in individuals with schizophrenia who have committed socially dangerous acts

Clinical aspects of behavioral dysregulation in individuals with schizophrenia who have committed socially dangerous acts

 

Authors

 

O.A. Makushkina

FSBI “V.P. Serbsky National Medical Research Center of Psychiatry and Narcology” of the Ministry of Health of the Russian Federation, Moscow, Russian Federation

A.V. Frolova

FSBI “V.P. Serbsky National Medical Research Center of Psychiatry and Narcology” of the Ministry of Health of the Russian Federation, Moscow, Russian Federation

E.V. Leurda

FSBI “V.P. Serbsky National Medical Research Center of Psychiatry and Narcology” of the Ministry of Health of the Russian Federation, Moscow, Russian Federation

N.G. Sharabidze

FSBI “V.P. Serbsky National Medical Research Center of Psychiatry and Narcology” of the Ministry of Health of the Russian Federation, Moscow, Russian Federation

 

https://doi.org/10.26617/1810-3111-2024-4(125)-36-46

 

Journal: Siberian Herald of Psychiatry and Addiction Psychiatry. 2024; 4 (125):  36-46.

 

Abstract

Background.The social danger of persons with mental disorders is characterized by a high prevalence of serious offenses and a significant rate of their repetition. At the same time, the problem of behavioral dysregulation in this category of patients with determination of its genesis and characteristics for prevention of repeated offenses has not been previously studied. Objective: to study the genesis of behavioral dysregulation in patients with schizophrenia who have committed socially dangerous acts (SDA). Materials. An observational descriptive study was conducted on the basis of State Budgetary Healthcare Institution of the Moscow Region “Psychiatric Hospital No. 2 named after V.I. Yakovenko”. The examined patients (n=65) aged 18-60 years (mean age – 38±10 years) with behavioral dysregulation, diagnosed with schizophrenia (F20) according to ICD-10, undergoing compulsory treatment after committing SDA. Methods: clinical-psychopathological, psychometric (using the Brief Psychiatric Rating Scale, the Structured Assessment of the Risk of Dangerous Behavior) method. Collection, adjustment, and systematization of the initial information were carried out in Microsoft Office Excel 2019. Statistical analysis was performed using IBM SPSS Statistics v.26. Results. The characteristics of this contingent were as follows: high prevalence of hereditary burden and pathology of early development, repeated suffering from exogenous harm leading to cerebro-organic damage; predominance in the premorbid period of emotionally unstable character traits with an asocial orientation of behavior, early onset of psychoactive substance use. The psychological characteristics of most respondents were affective rigidity, external locus of control with predominantly externally accusing methods of response, pronounced egocentrism, and inflated self-esteem. Common clinical characteristics of the disease process included: adolescence at the onset of the disease, a long continuous course with an increase in negative symptoms in the form of emotional inadequacy, paradoxical response, opposition, lack of empathy, rudeness of affective outbursts, combined with a pronounced disturbance of critical and prognostic abilities; the addition of comorbid addiction to alcohol/drugs. The predominance of three variants of psychopathological mechanisms for committing the delinquency was determined: a positive-psychotic mechanism with delusional motivation, a negative-personal mechanism of emotional uncontrollability, a negative-personal mechanism with the dominance of pathology of drives. These mechanisms were characterized by a specific dysregulation of patients' behavior with differences in disturbances of its motivation, productivity, arbitrariness and flexibility. Conclusion. The results of the study can be used to develop complex models of delinquency; algorithms for assessing the risk of its relapse; defining the prevention strategy based on the principles of personalized medicine and interdisciplinary interaction.

 

Keywords: schizophrenia, clinical features, behavioral dysregulation, social danger.

 

Article (pdf)

 

Contacts

This email address is being protected from spambots. You need JavaScript enabled to view it.

 

Materials  

For citation: Makushkina O.A., Frolova A.V., Leurda E.V., Sharabidze N.G. Clinical aspects of behavioral dysregulation in individuals with schizophrenia who have committed socially dangerous acts. Siberian Herald of Psychiatry and Addiction Psychiatry.2024; 4 (125): 36-46. https://doi.org/10.26617/1810-3111-2024-4(125)-36-46

 

REFERENCES

  1. De Vries Robbe M, de Vogel V, Douglas KS. Risk factors and protective factors: a two-sided dynamic approach to violence risk assessment. J. Forensic Psychiatry Psychol. 2013;24:440-457. doi:10.1080/14789949.2013.818162.
  2. Makushkina OA.Risk assessment of socially dangerous behavior of persons with mental disorders. Social and Clinical Psychiatry. 2017;27(3):49-55 (in Russian).
  3. Didenko AV. Program for control of impulsive behavior and anger within the framework of complex rehabilitation of convicts with personality pathology in places of deprivation of liberty. Medicine: new in theory and clinical practice: Materials of the scientific and practical conference with international participation. Tyumen Medical Journal. 2011;2:35-36(in Russian).
  4. Vazsonyi AT, Mikuška J, Kelley EL. It's time: A meta-analysis on the self-control-deviance link. JCrimJustice. 2017;48(1):48-63. doi: 10.1016/j.jcrimjus.2016.10.001.
  5. Malouf ET, Schaefer KE, Witt EA, Moore KE, Stuewig J, Tangney JP. The brief self-control scale predicts jail inmates' recidivism, substance dependence, and post-release adjustment. Pers Soc Psychol Bull. 2014 Mar;40(3):334-47. doi: 10.1177/0146167213511666. Epub 2013 Dec 17. PMID: 24345712; PMCID: PMC4485378.
  6. Popov SN. Comparison of clinical and criminological features of patients with organic mental disorders and schizophrenia who committed repeated socially dangerous acts. Doctor.Ru. 2022;21(4):67-71 doi: 10.31550/1727-2378-2022-21-4-67-71 (in Russian).
  7. Lysenko NE, Belyakova MYu. Features of behavior dysregulation in women having committed socially dangerous acts. Siberian Journal of Psychology. 2022;83:204-222. doi: 10.17223/17267080/83/11 (in Russian).
  8. Ostankov SB, Kameneva AI, Bol'shanin AV. Clinical and psychological predictors of the risk of committing socially dangerous actions in people suffering from schizophrenia. Current problems of psychiatry, narcology and medical psychology. Materials of the All-Russian scientific and practical conference with international participation dedicated to the memory of Professor AV Pogosov (using remote technologies). VA Lipatov, ed. Kursk, 2022:25-28(in Russian).
  9. Eshimbetova SZ, Chembayev BR. On the question of psychopathological mechanisms in committing the serious socially dangerous acts by patients with schizophrenia. Independent Psychiatric Journal. 2015;1:60-64 (in Russian).
  10. Chembayev BR, Eshimbetova SZ. Relationship of clinical presentation and psychopathological mechanisms during committing the grave socially dangerous acts by schizophrenic patients. Kazan Medical Journal. 2015;96(4): 536-542. doi: 10.17750/KMJ2015-536 (in Russian).
  11. Mal'tseva MM. Psychopathological mechanisms of socially dangerous actions of patients with mental disorders. Handbook of Forensic Psychiatry: a practical guide. Moscow: Publishing House YURAYT, 2021:213-226 (in Russian).
  12. Mal'tsevaMM, KotovVP. Dangerous actions of mentally ill persons. Moscow: Medicine Publishing House, 1995:256 (in Russian).