Clinical Characteristics and Pharmacological Treatment of Individuals With and Without Intellectual Disability in Pre-trial Assessment-A Population-Based Study

Hanna Edberg; Qi Chen; Peter Andiné; Henrik Larsson; Tatja Hirvikoski

doi:10.3389/fpsyt.2020.573989

Clinical Characteristics and Pharmacological Treatment of Individuals With and Without Intellectual Disability in Pre-trial Assessment-A Population-Based Study

Front Psychiatry. 2020 Oct 23:11:573989. doi: 10.3389/fpsyt.2020.573989. eCollection 2020.

Authors

Hanna Edberg^{1

2

3

4}, Qi Chen⁵, Peter Andiné^{6

7

8}, Henrik Larsson^{5

9}, Tatja Hirvikoski^{1

4

10}

Affiliations

¹ Department of Women's and Children's Health, Paediatric Neuropsychiatry Unit, Centre for Neurodevelopmental Disorders at Karolinska Institute (KIND), Karolinska Institute, Stockholm, Sweden.
² Northern Stockholm Psychiatric Clinic, Region Stockholm, Stockholm, Sweden.
³ Forensic Psychiatric Clinic, Region Stockholm, Stockholm, Sweden.
⁴ Center for Psychiatric Research, Region Stockholm, Stockholm, Sweden.
⁵ Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
⁶ Department of Psychiatry and Neurochemistry, Centre for Ethics, Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁷ Forensic Psychiatric Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁸ Department of Forensic Psychiatry, National Board of Forensic Medicine, Gothenburg, Sweden.
⁹ School of Medical Sciences, Örebro University, Örebro, Sweden.
¹⁰ Habilitation and Health, Region Stockholm, Stockholm, Sweden.

Abstract

Background: The current lack of knowledge about intellectual disability (ID) in forensic psychiatric contexts can compromise the legal certainty of these individuals during the medico-legal process. To address ambiguous results in previous literature, the aim of the current study was to estimate the prevalence of ID in a pre-trial forensic psychiatric settings. Moreover, as little is known about the characteristics of offenders with ID, we conducted a clinical characterization of individuals with and without ID being subject to forensic psychiatric assessment. Methods: Using data from several Swedish national registers, we conducted a population-based retrospective observational study on 8,442 individuals being subject to pre-trial forensic psychiatric assessments in Sweden in 1997-2013. We performed univariate analyses to compare the characteristics of individuals with (n = 537) and without ID (n = 7,905). Results: The prevalence of ID was 6.4% in the Swedish pre-trial forensic psychiatric context during the observational period. Compared with individuals without ID, individuals with ID were younger at the time of assessment, had a lower educational level, and had less frequently started families. ID was associated with lower frequency of diagnosed psychotic and bipolar disorders. However, a similar prescription rate of antipsychotics, and a comparable rate of previous inpatient care was observed among individuals with and without ID. Individuals with ID had more often been prescribed anti-libidinal treatments often used for treating sexual disorders, although did not present a higher prevalence of sexual disorder. Conclusions: The prevalence of ID among pre-trial individuals being subject to forensic psychiatric assessment was more than twice as high as assumed in the general population. Our results suggest that individuals with ID received pharmacotherapy without clear indication. Remaining challenges in the clinical management of individuals with ID were indicated by the discrepancy between the occurrence of psychiatric diagnoses, pharmacological treatment patterns, and rates of inpatient care.

Keywords: forensic psychiatric assessment; forensic psychiatry; intellectual disability (ID); mental retardation; neurodevelopmental disorders; pre-trial assessment.