Comparison of sociodemographic, clinical, and alexithymia characteristics of schizophrenia patients with and without criminal records

The number of studies in the field investigating the relationship between mental disorders and criminal behavior has progressively increased, primarily due to schizophrenia being identified as the mental disorder most strongly associated with criminal conduct. When examining studies exploring the association between crime and schizophrenia, significant attention has been directed towards identifying the risk factors for criminal behavior and aggressive actions among individuals diagnosed with schizophrenia. In this context, particular focus has been placed on understanding the relationships with sociodemographic, environmental, contextual, individual, familial characteristics, and clinical factors. Furthermore, the impact of co-occurring psychiatric disorders, particularly substance use disorders like alcohol use disorder, alongside schizophrenia, on the manifestation of criminal behaviors has also been scrutinized. The primary objective of our study is to delineate differences between individuals diagnosed with schizophrenia who have a criminal record and those diagnosed with schizophrenia without a criminal record in terms of sociodemographic and clinical characteristics, levels of intelligence and insight, alexithymia, psychological symptoms, aggression, and impulsivity violence. In doing so, we aim to determine whether these findings serve as predictive indicators in the commission and prediction of criminally relevant actions in individuals diagnosed with schizophrenia. The hypothesis of this study is that there is a difference in alexithymia characteristics between schizophrenic patients with a criminal record and schizophrenic patients without a criminal record. This study was conducted with patients aged 18-65 who presented to the Ankara University Faculty of Medicine Cebeci Hospital's Department of Forensic Psychiatry and General Psychiatry between November 2021 and November 2022, and who were diagnosed with 'schizophrenia' according to DSM-5 diagnostic criteria and received outpatient follow-up and treatment. Our study followed a case-control design, comprising 50 individuals with a criminal record and 50 individuals without a criminal record who were consecutively selected to form the study sample. The results of the study demonstrated statistically significant differences between the forensic case and control groups in terms of gender (χ2= 4.336, p=0.037), marital status (χ2= 13.279, p<0.001), and educational status (χ2=11.602, p=0.001). Furthermore, a significant difference was observed between the two groups in terms of hospitalization status (χ2=16.279, p<0.001). Additionally, it was determined that there was a significant difference in the difficulty describing feelings between the forensic case and control groups (t=-2.033, p=0.045), with the control group exhibiting higher scores on this subtest. Statistically significant differences were obtained between the two groups in terms of BPAQ total score (t= 5.281, p<0.001), the physical aggression subscale (t= 8.875, p<0.001), and the anger subscale scores (t= 3.524, p=0.001). Furthermore, there was also a statistically significant difference in terms of the BIS-11-SF total score (t=5.493, p<0.001), attention impulsivity (t= 5.935, p<0.001), motor impulsivity (t=3.847, p<0.001), and non planning (t=2.734, p=0.007) subscales. Regression analysis indicated that gender, marital status, educational status, age of illness onset, difficulty in verbalizing emotions, overall aggression level, physical aggression, anger, overall impulsivity level, attention impulsivity, motor impulsivity, and inability to plan were associated with forensic behaviors in patients with schizophrenia. While these findings exhibit parallels with some findings in the literature, there are also studies obtaining results divergent from our own. Therefore, there is a need for studies that encompass larger and more diverse sample groups and patients from different regions. Additionally, these studies should incorporate scales and methods that comprehensively analyze both positive and negative symptoms.