Moral cognition and homicide amongst forensic patients with schizophrenia and schizoaffective disorder: A cross-sectional cohort study

O’Reilly, Ken; O’Connell, Paul; Corvin, Aiden; O’Sullivan, Danny; Coyle, Ciaran; Mullaney, Ronan; O’Flynn, Padraic; Grogan, Katie; Richter, Melanie S.; Kennedy, Harry G

doi:10.1016/j.schres.2017.07.026

Cited by 8 publications

(23 citation statements)

References 9 publications

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“…To date within the forensic literature, emphasis has been placed on empirically investigating psychotic symptoms, such as delusions and hallucinations, for understanding acts of violence [8–11]. In contrast, the role played by the form and content of the associated moral reasoning has seldom been investigated [12, 13].…”

Section: Introductionmentioning

confidence: 99%

“…It is surprising that moral cognition has not been investigated as an important mediator given that laws for distinguishing those incapacitated because of mental illness from the criminally culpable emphasize confused moral reasoning [7, 12]. The psychology of moral cognition, namely what a person considers to be moral, is relevant for understanding serious violence because moral cognitions have a distinct set of qualities.…”

Section: Introductionmentioning

confidence: 99%

“…Recent evidence suggests that combatants are willing to die for what they perceive to be moral cognitions, even prioritising them over kin relations [33]. Serious violence like homicide is particularly likely to have a moral component [12, 24, 34]. Whilst the manifest reasons for the majority of homicides feature what criminologists have described as ‘trivial altercations’, the latent reasons concern powerful moral sentiments such as injustice and betrayal [34, 35].…”

Section: Introductionmentioning

confidence: 99%

“…Those who commit homicide may be willing to risk conviction and punishment in order to act in accordance with their moral cognitions [25, 26, 30, 31, 32, 37, 38]. Given that moral cognition is relevant for acts of violence amongst different populations [12, 13, 24, 33], and because of the properties of moral cognition itself [24–30], we speculated that moral cognition would play an important role for acts of violence by forensic patients.…”

Section: Introductionmentioning

confidence: 99%

“…While different cultures may regard some actions as unclean and others chaste, all cultures recognise impure acts. Moral cognitions associated with specific moral foundations may be particularly important for determining the seriousness of violence [12], in addition to the form of violence [45].…”

Section: Introductionmentioning

confidence: 99%

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Moral cognition, the missing link between psychotic symptoms and acts of violence: a cross-sectional national forensic cohort study

et al. 2019

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BackgroundPeople with schizophrenia are ten times more likely to commit homicide than a member of the general population. The relationship between symptoms of schizophrenia and acts of violence is unclear. There has also been limited research on what determines the seriousness and form of violence, such as reactive or instrumental violence. Moral cognition may play a paradoxical role in acts of violence for people with schizophrenia. Thoughts which have moral content arising from psychotic symptoms may be a cause of serious violence.MethodWe investigated if psychotic symptoms and moral cognitions at the time of a violent act were associated with acts of violence using a cross-sectional national forensic cohort (n = 55). We examined whether moral cognitions were associated with violence when controlling for neurocognition and violence proneness. We explored the association between all psychotic symptoms present at the time of the violent act, psychotic symptoms judged relevant to the violent act and moral cognitions present at that time. Using mediation analysis, we examined whether moral cognitions were the missing link between symptoms and the relevance of symptoms for violence. We also investigated if specific moral cognitions mediated the relationship between specific psychotic symptoms, the seriousness of violence (including homicide), and the form of violence.ResultsPsychotic symptoms generally were not associated with the seriousness or form of violence. However, specific moral cognitions were associated with the seriousness and form of violence even when controlling for neurocognition and violence proneness. Specific moral cognitions were associated with specific psychotic symptoms present and relevant to violence. Moral cognitions mediated the relationship between the presence of specific psychotic symptoms and their relevance for violence, homicide, seriousness of violence, and the form of violence.ConclusionsMoral cognitions including the need to reduce suffering, responding to an act of injustice or betrayal, the desire to comply with authority, or the wish to punish impure or disgusting behaviour, may be a key mediator explaining the relationship between psychotic symptoms and acts of violence. Our findings may have important implications for risk assessment, treatment and violence prevention.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Moral cognition, the missing link between psychotic symptoms and acts of violence: a cross-sectional national forensic cohort study

et al. 2019

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Psychiatrischer Beitrag

Ćurić

2020

Forens Psychiatr Psychol Kriminol

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Prospective cohort study of the evaluation of patient benefit from the redevelopment of a complete national forensic mental health service: the Dundrum Forensic Redevelopment Evaluation Study (D-FOREST) protocol

et al. 2022

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IntroductionSecure forensic mental health services are low volume, high cost services. They offer care and treatment to mentally disordered offenders who pose a high risk of serious violence to others. It is therefore incumbent on these services to systematically evaluate the outcomes of the care and treatment they deliver to ensure patient benefit in multiple domains. These should include physical and mental health outcomes, as well as offending related outcomes. The aim of Dundrum Forensic Redevelopment Evaluation Study (D-FOREST) is to complete a structured evaluation study of a complete national forensic mental health service, at the time of redevelopment of the National Forensic Mental Health Service for the Ireland.Methods and analysisD-FOREST is a multisite, prospective observational cohort study. The study uses a combination of baseline and repeated measures, to evaluate patient benefit from admissions to forensic settings. Patients will be rated for physical health, mental health, offending behaviours and other recovery measures relevant to the forensic hospital setting at admission to the hospital and 6 monthly thereafter.Lagged causal model analysis will be used to assess the existence and significance of potential directed relationships between the baseline measures of symptomatology of schizophrenia and violence risk and final outcome namely length of stay. Time intervals including length of stay will be measured by median and 95% CI using Kaplan-Meier and Cox regression analyses and survival analyses. Patient related measures will be rated as changes from baseline using general estimating equations for repeated measures, analysis of variance, analysis of covariance or logistic regression.Ethics and disseminationThe study has received approval from the Research Ethics and Effectiveness Committee of the National Forensic Mental Health Service, Ireland. Results will be made available to the funder and to forensic psychiatry researchers via international conferences and peer-reviewed publications.Trial registration numberNCT05074732.

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Moral cognition and homicide amongst forensic patients with schizophrenia and schizoaffective disorder: A cross-sectional cohort study

Abstract: Forensic patients with schizophrenia who had carried out a homicide scored higher on a measure of moral cognition (MFQ-30) than other violent patients. Neurocognitive impairment was associated with homicide by mediation via higher scores for in-group loyalty.

Cited by 8 publications

References 9 publications

Moral cognition, the missing link between psychotic symptoms and acts of violence: a cross-sectional national forensic cohort study

Moral cognition, the missing link between psychotic symptoms and acts of violence: a cross-sectional national forensic cohort study

Psychiatrischer Beitrag

Prospective cohort study of the evaluation of patient benefit from the redevelopment of a complete national forensic mental health service: the Dundrum Forensic Redevelopment Evaluation Study (D-FOREST) protocol

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