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Objective: To explore the direct and Indirect costs in a cohort of 225 risperidone-treated patients with schizophrenia followed up annually during 5 years. Method: Data on costs for medication, hospitalization, sheltered living and productivity losses, as well as degree of social isolation, were collected. Results: The direct costs were dominated by hospitalization and sheltered living expenses, while drug costs only represented 7% of the direct costs. Indirect costs represented 43% of the total costs during the 5 years. About 12% worked full-time, and 12% worked part-time, implying large productivity losses. As a consequence of the national mental health care reform, a substantial shift of costs from hospital care to sheltered living took place on the national level, but the reduction of hospital days for the study patients over time was much larger suggesting that the switch from first to second generation compounds was therapeutically successful. A high degree of social isolation was seen, with more than 20% being completely without social contacts and 30% seeing friends/relatives less often than once a week. Conclusion: The economic costs of schizophrenia are high and driven by the need for assisted living and hospitalizations, together with productivity losses. In addition, the intangible costs, such as social contacts, are also high.

Objective: Explore the long-term course of schizophrenia and related disorders. Method: Naturalistic study of 225 patients initially treated with risperidone (monotherapy or in combination with other psychotropic drugs) over 5 years. Results: Stable symptomatology and side effects were observed. Clinician GAF scores were 55-61, but patients' self-ratings were higher. Clinician and patient CGI scores were at the same level. Annual in-patient days decreased but days in sheltered accommodations increased still more. Only 12% of the patients studied or worked fulltime. One in four had no social contacts except with staff. Eight patients died during the 5 years. Conclusion: The findings underline the chronicity and seriousness of psychotic disorders in terms of social outcome and, indirectly, the low quality of life of this group of persons. Patients were generally well aware of their illness and able to sort out symptoms from drug side effects. This opens for more active involvement of patients in monitoring their own treatment.

This article presents reasons for undertaking "The Comparative Study of the Prevention of Crime and Violence by Mentally Ill Persons" and reasons for decisions regarding the study design and choice of measures. A brief portrait of the forensic patients that have been recruited is also presented. Community treatment programs could offer long-term cost-effective care for offenders with major mental disorders (MMDs). The study aims to identify the necessary ingredients of an effective program. Sites are selected in four countries where identification of most, if not all, persons with MMD who commit crimes within the catchment area was possible. Within each site, two samples of patients with MMD are recruited, one from a forensic hospital and one from a general psychiatric hospital. Assessments are completed prior to discharge. Participants are followed during a 5-year period. Comparisons of the forensic patients recruited in the four sites indicate many more similarities than differences. © 2007 American Association for Correctional and Forensic Psychology.

It is known that offenders with immigrant backgrounds are over-represented in criminal as well as forensic psychiatric populations and that the prevalence of dyslexia among prisoners with Swedish as a native language is much higher than in the general population in Sweden. The aim of this study was to diagnose dyslexia in a sample of 23 male offenders with immigrant backgrounds undergoing a forensic psychiatric investigation with the objective to discuss the appropriateness of a commonly used assessment procedure in accordance with DSM-IV. Dyslexia was diagnosed individually; the participants took reading and writing tests, as well as intelligence and neuropsychological tests. Nine out of 23 participants (39%) were diagnosed as having dyslexia. Thus, dyslexia seems to be common among male offenders with immigrant backgrounds undergoing FPI, and for that reason it is important to investigate their reading and writing abilities. Dyslexia is regarded as a functional impairment in Sweden, and therefore all offenders with dyslexia undergoing a forensic psychiatric investigation, irrespective of their background, should receive help with the legal procedure, for example their crime files and police investigation documents should be read to them. We conclude that in addition to the criteria in DSM-IV the assessment procedure should be extended with phonological tests.

This study evaluated the structural reliability, construct-related validity, and cultural validity generalization of the Hare Psychopathy Checklist: Screening Version (PCL:SV) in a sample of more than 560 male and female Swedish forensic psychiatric treatment patients, forensic evaluation patients, and criminal offenders. Structural reliability was excellent for most indices. PCL:SV scores were higher for males than females for total and Part 1 scores (interpersonal/ affective features) but not for Part 2 (behavioral features). With some exceptions, PCL:SV scores were meaningfully related to aggression to others, a measure of risk for violence, substance use problems, personality disorder (positive), and psychosis (negative). Correlations between PCL:SV and aggression were larger for females than males, although the difference was smaller when personality disorder was held constant. The structural reliability and pattern of validity coefficients were comparable in these Swedish samples to other non-North American samples. Implications for the cross-cultural manifestation and correlates of psychopathy are discussed.

Purpose. The predictive validity of the risk prediction instrument HCR-20 was studied. Methods. Two matched groups of discharged forensic psychiatric patients, one who had recidivated into violent criminality and the other not, were assessed with the HCR-20. This was done retrospective and blind to the outcome. Results. The results show an overall high predictive validity (AUC = .80). However, historical data had none, or a low, validity while clinical and risk management data had a very high validity. Conclusions. One of the most interesting findings in this study is that clinical and risk management factors came out as more predictive of future violence than historical factors, which is very much contrary to findings in past research. We think that one has to bear in mind that both clinical and risk management factors are heavily influenced by historical information. Thus, historical data are probably as important as is generally shown in follow-up studies of violence in various offender groups. However, using the HCR-20, which allows systematic and reliable coding of clinical and risk management factors, seems to make it possible to use these factors more successfully than has been hitherto possible.