title: Previous forensic mental examination is a useful marker indicating effective violence relapse prevention among psychotic patients.
abstract: BACKGROUND
  Patients with schizophrenia have an increased risk of violent behavior.
  
  
  OBJECTIVE
  The aim of this study was to find predictive indicators of high risk of violent behavior among outpatients with psychosis.
  
  
  METHODS
  A total of 206 individuals were involuntarily ordered to hospital treatment as forensic patients after a forensic mental examination in Finland from 1995-1999. The information was collected from the registers of the National Authority for Medicolegal Affairs, and was obtained from 194 persons of which 184 had been accused of a violent crime.
  
  
  RESULTS
  Twenty percent (22/110) of those forensic patients, who had received a psychosis diagnosis before the index crime, had previously undergone a forensic examination. This subgroup was 12% of the total study population (22/184), which is about 300 times higher than expected (i.e. if no risk increase assumed). Ten of the 22 persons in this subgroup had been committed in forensic psychiatric inpatient care and later discharged. The same number of persons had been sentenced to prison and subsequently released after the previous forensic mental examination.
  
  
  CONCLUSIONS
  While primary prevention of crime for the larger population of all patients with psychosis is not feasible, secondary prevention (prevention of reoffending) might be possible by focusing on the small subgroup, which had undergone a previous forensic mental examination. Obligatory follow-up and treatment in outpatient care would probably decrease recidivistic offending among discharged forensic psychiatric patients and among those offenders found not guilty by reason of insanity but not considered to fulfill criteria for involuntary hospital treatment.
authors.affiliation: Kristiina Kivimies, Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital , Kuopio , Finland.
authors.forename: Kristiina
authors.initials: K
authors.lastname: Kivimies
authors.forename: Eila
authors.initials: E
authors.lastname: Repo-Tiihonen
authors.forename: Hannu
authors.initials: H
authors.lastname: Kautiainen
authors.forename: Jari
authors.initials: J
authors.lastname: Tiihonen
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000379:methods; D003415:Crime / Q000523:psychology*; D057237:Criminals / Q000523:psychology; D005260:Female; D005555:Forensic Psychiatry / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011618:Psychotic Disorders / Q000523:psychology*; D012307:Risk Factors; D055502:Secondary Prevention; D014754:Violence / Q000517:prevention & control / Q000523:psychology*; D055815:Young Adult
keywords: Forensic psychiatry; Mental examination; Prevention; Violence