Investigation of the effect of theory of mind functions, childhood trauma, impulsivity and aggression levels on repetitive criminal behavior in patients with schizophrenia and comparison with healthy controls

Investigation of the Effect of Theory of Mind Functions, Childhood Trauma, Impulsivity and Aggression Levels on Repetitive Criminal Behavior in Patients with Schizophrenia and Comparison with Healthy Controls Background and Aim: The fact that some schizophrenic patients engage in criminal behavior has led to the need to examine these patients in terms of various factors. In this study, we compared single-offending schizophrenia patients and multi-criminal schizophrenic patients and healthy volunteers in terms of theory of mind functions, insight, impulsivity, aggression, childhood trauma, and difficulties in emotion regulation and determined which of these factors were more closely related to repetitive delinquency intended to examine. Materials and Methods: Among the inpatients followed up in Ankara City Hospital High Security Forensic Psychiatry unit, 25 single offender schizophrenia patients (SC) in remission who were diagnosed with Schizophrenia Spectrum Disorder according to DSM-5 and met the inclusion criteria, and 25 schizophrenia patients who committed repetitive crimes (RC) and 25 healthy controls (HC) aged between 18-65, whose gender and education were matched, were included in the study. The sociodemographic data of the patients such as their age, educational status, occupation, duration of illness, history of use of antipsychotic drugs, whether there was depot treatment, and forensic crime stories were noted. The Ekman Facial Expression Test and Reading the Mind in the Eyes Test(RMET) to measure ToM functions, The Difficulties in Emotion Regulation Scale (DERS), the Childhood Trauma Scale(CTS) ,the Buss-Perry Aggression Scale to assess aggression, the Barrat Impulsivity Scale to assess impulsivity, together with a sociodemographic data form for patients and healthy control groups applied. In addition, the Taylor Crime Severity Rating Scale and the PANNS, Global Assessment of Functioning Scale (GAS) and Three Components of Insight Evaluation Scale were applied to the patient group in order to determine their psychopathology, insight and functionality levels. Results: Unemployment, singleness, and living alone rates are higher for schizophrenic patients who have committed crimes compared to HC. Among the clinical variables between the SC and RC groups, only functionality was significantly lower in the RC group (p=0.04). DERS total and DERS Strategies scores were significantly lower in RC compared to TS (p=0.005). There was no significant difference between the three groups in terms of CTS, only emotional neglect was higher in HC than in the SC and RC groups (p<0.001). While impulsivity and aggression were not different between RC and SC, impulsivity and physical aggression were higher than HC in the delinquent schizophrenia group (p<0.05). ToM tests were significantly lower than HC in the delinquent schizophrenia group, but there was no difference between SC and RC (p>0.05). Disgusted emotion recognition was higher in patients with schizophrenia who committed crimes against people than in patients with other crimes with schizophrenia (p=0.009). In those who committed violent crimes, the duration of illness was shorter, functionality and DERS awareness were lower, and the rate of substance use was higher (p=0.023 p=0.005 p=0.050 p=0.044, respectively). CTS physical abuse was found to be higher in the non-violent group (p=0.056). It was found that the increase in motor impulsivity, CTS emotional abuse, DERS strategies scores and decrease in functionality were associated with being in the single/repetitive crime group, and emotional abuse score predicted being in the recurrent crime group. While less recognition of happy facial expressions, less awareness of emotion regulation difficulties, and a history of substance use were associated with committing a violent crime in the SC group, short illness duration, treatment nonadherence, substance use, low functionality, and DERS strategies score were associated with an increase in crime severity in the SC group and low functionality predicted the severity of crime. In all delinquent schizophrenia group, young age, short illness duration, inability to recognize happy face, low functionality, substance use were found to be associated with committing a violent crime, and short illness duration, low functionality and not being able to recognize happy face were found to predict severity of crime. In the schizophrenia group, it was determined that the number of crimes committed increased as the duration of the illness and the level of functionality decreased and the time to admission to the hospital, the number and duration of hospitalization, and the number of suicides increased. No significant relationship was found between PANSS and insight and the number of crimes. Physical-verbal aggression, attention-motor-unplanned impulsivity, increase in CTS and DERS subscale scores, decrease in emotion recognition from RMET and Ekman faces, and inability to recognize especially fearful, angry, disgusted emotion were associated with an increase in the number of crimes. In addition, RMET and unplanned impulsivity was found to be the predictor of the number of crime. Conclusion: These findings may point out that some clinical markers are effective on repetitive delinquency and may guide strategies to prevent repetitive delinquency in patients with a single criminal record with targeted interventions in these areas. Our study, as far as we can see, is the first study in this scope to evaluate the factors affecting repetition of delinquency in schizophrenia patients with various clinical data and other scales besides theory of mind, and expands the existing data on criminal behavior in schizophrenia. Keywords: Schizophrenia, Repetitive Crime, Violence, Social Cognition, Theory of Mind, Impulsivity, Aggression