Predictors of criminal offending in a clinical sample of patients diagnosed with schizophrenia: A 6-year follow-up study.

Criminal behavior in schizophrenia has been associated with a number of risk factors including symptoms of schizophrenia, co-occurring personality disorders (PDs), substance abuse, intellectual and cognitive dysfunctions, history of violence, and a number of sociodemographic variables. However, the relative importance and predictive power of these factors when considered simultaneously is understudied. In this 6-year follow-up study, we examined the association of these factors with criminal offending in a sample of 108 patients diagnosed with schizophrenia (80.6% men). The proportion of offenders during the follow-up period was 53.7%. A cox proportional hazards model showed that Facet 3 and Facet 4 of the Hare Psychopathy Checklist–Revised, passive–aggressive PD, narcissistic PD, and Global Assessment Functioning were the only significant predictors of offending when all putative risk factors were considered simultaneously. Results also revealed high predictive accuracy of the total score of the Hare Psychopathy Checklist–Revised for offending. Of all potential predictors considered, personality pathology and specifically the antisocial facet of psychopathy emerged as the main predictor of criminal behavior in patients with schizophrenia. These results underscore the importance of including an assessment of personality pathology, including psychopathy, in the evaluation of risk for violence and crime in schizophrenia.