Psychopathic traits in Finnish homicide offenders with schizophrenia Taina Laajasalo a, ⁎, Stephan Salenius b , Nina Lindberg c , Eila Repo-Tiihonen d , Helinä Häkkänen-Nyholm a, e a Institute of Behavioural Sciences, P.O. Box 9, 00014 University of Helsinki, Finland b Department of Psychiatry, Peijas, Helsinki University Central Hospital, P.O. Box 900, 00029 HUS, Vantaa, Finland c Department of Adolescent Psychiatry, Helsinki University Central Hospital, P.O. Box 590, 00029 HUS, Helsinki, Finland d Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, FI-79240 Kuopio, Finland e National Bureau of Investigation, Forensic Laboratory, P.O. Box 285, 01301 Vantaa, Finland abstract article info Available online 17 September 2011 Keywords: Psychopathy Schizophrenia Homicide Violence PCL-R There is a paucity of studies examining psychopathy in comparable samples of violent individuals with and without psychotic illness. The main goal of the study was to assess the prevalence and nature of psychopathic traits as measured by PCL-R among Finnish homicide offenders with schizophrenia. Further, the impact of co- morbid psychopathy on the homicidal incidents, as well as the associations of psychopathy and offender background factors, among offenders with schizophrenia was investigated. A retrospective study was performed using extensive forensic psychiatric evaluation reports and crime re- ports as sources of information. The sample consisted of 72 homicide offenders with schizophrenia and 72 controls without psychotic illness. Psychopathic features were prevalent among Finnish homicide offenders with schizophrenia, although for the most parts to a lesser extent compared to other homicide offenders. Like non-mentally ill psychopathic offenders, offenders with schizophrenia and many psychopathic traits are likely to present early starting problems in many areas of life and they also commit homicides that resemble other psychopathic offenders' in their choice of victims, intoxication and post-offense behavior. The observed prevalence of psychopathic traits highlights the importance of psychopathy assessment among violence-prone individuals with schizophrenia. In most respects, offenders with schizophrenia and high levels of psychopathic traits seem to be similar to psychopathic offenders without psychotic illness, which has implications for early intervention and management. © 2011 Elsevier Ltd. All rights reserved. 1. Introduction Modern psychopathy criteria first described by Cleckley (1976) con- sists of a set of affective, interpersonal and behavioral features, such as shallow emotions, lack of empathy, guilt or remorse, persistent violation of social norms and expectations, impulsivity and irresponsibility (Hare, 1991; Hare, 2003). Operationalization of psychopathy was made possi- ble by the introduction of the Psychopathy Checklist (PCL and PCL-R; Hare, 1980 and Hare, 1991). PCL and its derivatives have impressive psy- chometric properties and they have been fundamentally important to our understanding of psychopathy. Since the presentation of PCL, several studies have focused on examining the comorbidity of psychopathy and other psychiatric disorders (for a review see e.g. Widiger, 2006), includ- ing major mental disorders such as schizophrenia. A few decades ago it was thought that schizophrenia and psychop- athy are incompatible and rarely occur together, mainly because the early studies were conducted among prison populations with few se- riously mentally disordered offenders (Hare, 2003). Indeed, among general forensic populations the comorbidity of schizophrenia and psychopathy is relatively low, under 5%, and the correlations found between the two disorders have usually been negative (Hart & Hare, 1989; Hildebrand & de Ruiter, 2004; Hodgins, Côté, & Toupin, 1996; Rice & Harris, 1995). However, among seriously violent pa- tients with a mental illness, the comorbidity appears to be as high as 16–20% (Abushua'leh & Abu-Akel, 2006; Nolan, Volavka, Mohr, & Czobor, 1999; Tengström, Grann, Långström, & Kullgren, 2000). Patients with schizophrenia and high psychopathy are more likely to be non-compliant with treatment programs and have poorer insti- tutional outcome (Dolan & Davies, 2006; Kunz et al., 2004). Criminal histories are lengthier (Blackburn & Coid, 1999), risk of recividism (Tengström et al., 2000) and violence (Fullam & Dolan, 2006a; Nolan et al., 1999) higher. Additionally, patients with schizophrenia and high psychopathy scores show similar deficits in emotional infor- mation processing to those reported in non-psychotic psychopathic samples, have higher levels of grandiose and hostile symptomatology, and have a less compliant interpersonal style as well as higher scores on trait impulsivity and aggression (Fullam & Dolan, 2006a, 2006b). International Journal of Law and Psychiatry 34 (2011) 324–330 ⁎ Corresponding author. Tel: + 358 44 0220044. E-mail addresses: taina.laajasalo@helsinki.fi (T. Laajasalo), stephan.salenius@hus.fi (S. Salenius), nina.lindberg@hus.fi (N. Lindberg), eila.tiihonen@niuva.fi (E. Repo-Tiihonen), helina.hakkanen-nyholm@helsinki.fi (H. Häkkänen-Nyholm). 0160-2527/$ – see front matter © 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.ijlp.2011.08.004 Contents lists available at SciVerse ScienceDirect International Journal of Law and Psychiatry