Psychotische patiënten in de TBS: achtergronden, delictgedrag en behandeling

Abstract

About a quarter of the TBS-patients suffer from major psychotic disorders, suchas schizophrenia. This paper addresses the specific backgrounds and characteristicsof these psychotic forensic patients and the treatment and care they receivein forensic hospitals. To this end, their life histories (e.g., ethnic background,childhood living conditions, and educational level) and criminal histories (e.g.,age at first conviction, number of convictions, and nature of the offences) werecompared to those of the other (mainly personality disordered) forensic patientsfrom two forensic hospitals. Childhood living conditions of the psychoticoffenders appeared to have been relatively 'normal', compared to those of theother offenders. This is to say that 85% of the 111 included psychotic patientsgrew up in their original biological environment, compared to 60% of the nonpsychoticoffenders. The average educational level of the psychotic forensic patientsalso turned out to be higher, compared to the control group. Relativelyoften (77%), psychotic offenders had received some form of psychiatric carein the past before they committed the offence that led to the current forensicpsychiatric incarceration. Most psychotic forensic patients (66%) were hospitalizedin one of the two forensic hospitals under study for violent crimes, such asaggravated assault or manslaughter, whereas sexual offences were relatively rare(8%) among the psychotic offenders. In this paper, the specific treatment andcare that psychotic forensic patients need are also addressed. Main componentsof their treatment are the use of anti-psychotic medication, intensive psychoeducationabout their psychiatric disorder, improvement of skills, and gainingmore insight in warning signs that may signal a worsening of the psychiatricconditions of the patients.