Poor Executive Functioning Associated with the Risk of Aggressive Behavior Recidivism in the Forensic Community in Schizophrenic Patients

Abstract

Objective: The aim of this study was to investigate the relationship between the risk of aggressive behavior recidivism and poor executive functioning in a forensic setting in schizophrenic patients. Methods: The data were collected over a two-year time period. The subjects in the study included 65 male adults ≥18, with schizophrenia disorder using SCID based on the DSM-IVR criteria and evaluated using PANSS, HCR-20, PCL-R and neuropsychological testing of the cognitive domains MMSE, WAIS-R, Stroop Color and Word Test, TMT A and TMT B tests. After a two-year follow up for recidivism of aggressive behavior, the subjects of the recidivism group were compared with a group showing no recidivism in terms of executive functioning, risk assessment, psychopathic and clinical psychopathology. Results: The recidivism group revealed significantly lower and poorer scores in Stroop Color, Stroop Word, Verbal IQ, TMT A and TMT B tests than those belonging to the non-recidivism group. Logistic regression analysis determined that the poor verbal IQ and executive functions measured using the Stroop Word test were the strongest predictors of violent recidivism rate even age at first violence, social status, PANSS, PCL and total IQ factor accounted for. Conclusion: Poor executive functioning appears to be associated with a high risk of aggressive behavior recidivism during mandatory treatment among the forensic community in patients with schizophrenia disorder. Neuropsychological assessments of executive dysfunction might probably identify psychiatric inpatients that could be at high risk for aggressive behavior recidivism in forensic settings.

Keywords

• aggressive behavior
• executive function
• risk assessment
• schizophrenia.