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ResumenSe investigó la relación entre los intentos de suicidio y diferentes factores de vulnerabilidad en 61 sujetos varones durante el examen psiquiátrico forense. Los rasgos de personalidad y la psicopatía se determinaron por medio de las Escalas Karolinska de la Personalidad (KSP) y la Lista de Psicopatía Revisada (PCL-R). Los diagnósticos clínicos se determinaron por el uso de la Entrevista Clínica Estructurada para el DSM-III-R (SCID). La actividad de la monoaminooxidasa (MAO) de las plaquetas se investigó en 58 sujetos. Los pacientes que intentaron suicidarse tenían puntuaciones sumamente bajas en socialización y altas en agresión impulsiva. Esto era independiente de que existieran antecedentes de reincidencia en delitos violentos o no. Estos sujetos tenían puntuaciones más altas en la PCL-R y niveles más bajos de actividad de la MAO de las plaquetas que los que no intentaron suicidarse. No se encontró relación entre los intentos de suicidio y la reincidencia en delitos violentos. Sin embargo, entre los sujetos con reincidencia en delitos violentos había una diferencia muy significativa entre quienes intentaron suicidarse y quienes no, lo que indica perfiles de personalidad diferentes en los delincuentes violentos con y sin comportamiento suicida. El comportamiento suicida se asociaba significativamente con el trastorno límite de la personalidad, pero no con ningún otro trastorno individual del DSM-III-R. Los resultados muestran una perturbación de la personalidad mucho más grave en los pacientes que intentaron suicidarse que en otros pacientes violentos en este tipo de población. Por tanto, la conducta suicida se debería evaluar y tratar per se.

SummaryThe relationship between suicide attempts and different vulnerability factors was investigated in 61 male subjects during forensic psychiatric examination. Personality traits and psychopathy were determined by means of the Karolinska Scales of Personality (KSP) and the Psychopathy Checklist-Revised (PCL-R). Clinical diagnoses were determined by the use of Structured Clinical Interview for DSM-III-R (SCID). Platelet monoamine oxidase (MAO) activity was investigated in 58 subjects.Suicide attempters had extremely low socialization and high impulsive aggression. This was independent of a history of repeatedly criminal violence or not. They had higher PCL-R scores and lower levels of platelet MAO activity than non-attempters. No relationship was found between suicide attempts and repeated violent criminality. However, among the subjects with repeated criminal violence there was a highly significant difference between suicide attempters and non-attempters, indicating different personality profiles in violent offenders with and without suicidal behavior. Suicidal behavior was significantly associated with borderline personality disorder, but not with any other single DSM-III-R disorder. The results show a far more severe personality disturbance in suicide attempters than in other violent patients in this type of population. Suicidal behavior should therefore be evaluated and treated per se.

In a Swedish study, delinquent boys had high serum levels of triiodothyronine (T3). Furthermore, former delinquents, followed up after about 30 years, had T3 levels significantly related to repeated criminality. The aim of the present study was to shed further light on the relationship between the thyroid hormones and specific behaviors and personality characteristics.Serum levels of T3 and free thyroxine (FT4) were measured in 61 nonpsychotic male subjects at forensic psychiatric examinations and 66 normal controls. Psychopathy was determined by means of the Psychopathy Checklist-Revised (PCL-R) and DSM-III-R, DSM-IV, and ICD-10 diagnoses.The study population had high T3 and low FT4 values. Elevated T3 levels were related to type II alcoholism, Cluster B personality disorders, psychopathy as measured by the PCL-R, criminality, a diagnosis of a DSM-IV antisocial disorder, and an ICD-10 dissocial disorder. Serum levels of FT4 were negatively related to the same disorders and personality traits.The results indicate an intimate relationship between T3 and FT4, and abuse and antisocial behavior. They emphasize the importance of further studies on T3 as a biological marker for abuse, social deviance, and repeated violent behavior.

Platelet monoamine oxidase (MAO) activities were determined in 58 non-psychotic males at forensic psychiatric examinations. The aim of the study was to investigate the role of platelet MAO activity as a biological marker in forensic psychiatry, a clinical field with growing need of safe predictors for both treatment outcome and behavior. The study population was heterogeneous with respect to clinical and personality disorders and personality traits. The results confirmed the role of platelet MAO activity as a biological marker for stable personality traits such as impulsiveness, monotony avoidance and aggressiveness. Disorders with high frequencies of these personality traits such as borderline personality disorder and type II alcoholism could secondarily be associated with low levels of platelet MAO activity, whereas no such associations could be found regarding other clinical or personality disorders. Neither psychopathy as assessed by the means of PCL-R nor behavior such as abuse or criminality could be associated with platelet MAO activity. The conclusion is that, due to its close relationship with stable personality traits, platelet MAO activity serves a marker for vulnerability also in forensic psychiatric populations. On the other hand it is not a marker for clinical or personality disorders, or behavior per se.

Assessment of personality traits by means of the Karolinska Scales of Personality (KSP) was made in connection with a forensic psychiatric investigation and at follow-up after 2 years. For some subjects, major life events had occurred between the assessments - in some cases positive events such as marriage, having children, starting regular studies or employment, or receiving psychotherapeutic treatment. In many cases. however, the events or circumstances during the 2-year interval were negative, such as relapse in criminality, incarceration in prison for the whole period between the ratings, or development of a schizophrenic disorder. Moreover, the second assessments were performed in various settings. No significant differences between the two ratings were found in the traits Impulsiveness, Monotony avoidance, or Socialization. Measures of Indirect and Verbal aggression and Irritability also remained stable, as did measures of Guilt and Social desirability. Thus. KSP personality traits related to psycho...

This study is a follow-up investigation of a forensic psychiatric sub-population 6-8 years after forensic psychiatric evaluation. The aim was to examine the long-term validity of biological markers of psychopathy and antisocial behavior over time. Data on criminal records were obtained at follow-up from the National Council for Crime Prevention. Basic data included findings of psychiatric and psychological assessments, as well as values for serum triiodothyronine (T3) and free thyroxin (FT4), and platelet monoamine oxidase (MAO) activity, all obtained during the forensic psychiatric examination. Criminal recidivists at follow-up had higher serum T3 levels than non-recidivists, and much higher values than normal controls, while their levels of free T4 were lower. The T3 levels in criminal recidivists correlated to psychopathy- and aggression-related personality traits as measured by the Karolinska Scale of Personality. In violent recidivists, a remarkably high correlation was noted between T3 levels and Irritability and Detachment, traits that have previously been linked to the dopaminergic system. Stepwise multiple regression analyses confirmed the relationships of T3 levels and platelet MAO activity with personality traits in criminal recidivists. The predictive validity of biological markers of psychopathy, T3 and platelet MAO, measured during forensic psychiatric investigation, is stable over time. The results indicate chronic alterations of the hypothalamic-pituitary-thyroid axis in this group of subjects.