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German Journal of Psychiatry

ISSN 1433-1055

 

Alcohol-related symptoms in a sample of male forensic psychiatric patients and a normal representative cohort of Swedish males

 

 

Peter Wennberg1 and  Anna Maria Dåderman1,2

 

1Department of Psychology, Stockholm University, Sweden.

2Department of Clinical Neuroscience, Occupational Therapy and Elderly Care Research, Division of Forensic Psychiatry, Karolinska Institute


 

 

Corresponding author: Peter Wennberg, Department of Psychology, University of Stockholm, S-106 91 Stockholm, e-mail: prwg@psychmax.psychology.su.se


 

Acknowledgement: The work by Peter Wennberg in this study was supported by grants from the Swedish Council for Social Research, the Swedish Alcohol Research Fund, the Swedish Council for Research in the Humanities and Social Sciences, the Bank of Sweden Tercentenary Foundation, and the Swedish Council for Planning and Co-ordination of Research. The work by Anna Maria Dåderman was supported by grants from the Swedish Foundation for Health Care Sciences and Allergy Research, the Söderström-Königska Foundation, and the Swedish National Board of Forensic Medicine.


 

Abstract

 

The purpose of the present study was to compare alcohol habits in a forensic psychiatric sample to those of a normal representative one with respect to alcohol-related symptoms. Two male samples were compared with respect to self-reported alcohol-related symptoms, a forensic psychiatric sample (n=60; mean age 27 years) and a control sample (n=106; mean age 36 years). As expected, there was a higher proportion of alcohol-related symptoms in the forensic psychiatric sample. The frequencies of specific symptoms were compared between the samples (German J Psychiatry 2000;3:21-26).

 

Key words: Alcohol, forensic psychiatry

 

Received: Dec. 18, 2000

Published: Jan. 25, 2000


 

 

Introduction

Both criminality (Collins, 1982; Andersson, Mahoney, Wennberg, Kühlhorn & Magnusson, 1999) and a large number psychiatric disorders (Helzer & Pryzbeck, 1985; see a review in Angold, Costello & Erkanli, 1999) have been shown to frequently co-occur with alcohol problems and alcohol consumption. Thus, when screening for alcohol problems in a forensic psychiatric population, the expected ratio of individuals with alcohol problems is substantially higher than in the general population (Dobkin, Dongier, Cooper & Hill, 1991; Harper & Harper, 1981).

 

The purpose of this study was to compare alcohol habits in a forensic psychiatric sample to those of a normal representative one with respect to alcohol-related symptoms.

 

Method

The forensic psychiatric sample

The subjects (n = 60) were recruited from male inpatients accused of committing a crime from the Department of Forensic Psychiatry in Stockholm, with a mean age of 27 years (SD 5.7 years, range 16 to 35 years). All were remitted for a psychiatric examination, before being sentenced. Over about one year, all male subjects (not more than 35 years of age) were asked (by the second author - A.M.D.) to participate in a research project on reading and writing disabilities/dyslexia. Exclusion criteria were: need of an interpreter, not allowed by the team to participate because of obvious psychotic disorder or mental retardation. Medication was not a reason for exclusion. All subjects were accused of a serious crime (in Sweden, a court cannot request a major forensic psychiatric investigation unless there is convincing evidence of the person's guilt and not when only a fine is possible). The research project on reading and writing disabilities/dyslexia also includes studies of personality characteristics, self-esteem, platelet monoamine oxidase (MAO) activity, executive functions, and abuse. Sixty-seven per cent of the subjects had two Swedish-born biological parents. The project received approval by the ethics committee at the Karolinska Hospital. All subjects completed an informed consent form.

The control sample

The control sample used in this study was the male birth cohort of the Solna project, a longitudinal research project run by the Stockholm Laboratory for Individual Development. It consists of a "birth-to-maturity" study for which there is detailed information on each subject from birth to the age of about 36 years. The project was originally one of several internationally co-ordinated investigations. It was started in 1954, by Arvid Wallgren, Petter Karlberg and Gunnar Klackenberg, with the general aim of prospectively studying the physical and mental growth and development of a representative group of Swedish children. The children were recruited from antenatal clinics in a suburban community outside the City of Stockholm. Socio-economically, their parents were found to be representative of the population of the city as a whole (Karlberg et al., 1968). A huge amount of information on these persons’ physical, psychological and social development has been prospectively collected, from infancy through to maturity (Klackenberg, 1971). Alcohol data for the control sample in this study refers to the data-collection when the subjects where on average 36 years old (34-37). In total 106 subjects participated in this data collection - giving a response-rate of 91 percent of the subjects alive. Of the 16 subjects who did not participate, five subjects had died (two traffic accidents, one suicide, one overdose and one due to cancer), five refused to participate and six could not be interviewed for other reasons (e.g. emigration).

Data

Alcohol habits in the two samples were described by seven questions: 1) What is your consumption like? (too high/a little too high/satisfactory/don’t drink. 2) Has anyone seriously criticised your alcohol habits? 3). Have you had memory lapses due to alcohol drinking? 4) Have you noticed that you need to drink more now to get intoxicated compared to when you started drinking? 5) Have you ever taken an eye-opener in the morning after drinking alcohol? 6) Have you ever done something dangerous under the influence of alcohol? 7) Have you received treatment for alcohol problems? These questions were asked in interviews to individuals in the two samples with the same procedure and under similar circumstances. The questions described above exists in some form in frequently used screening tests such as CAGE, Mn-MAST (Nyström et al, 1993) or AUDIT (Wennberg, 1996). An evaluation of these questions has also been done as poster in the German Journal of Psychiatry (Wennberg & Dåderman, 1999). Treated as a 7-item scale, the internal consistency was 0.72 in the forensic psychiatric sample and 0.62 in the control sample. The higher internal consistency in the forensic sample could probably be explained by higher variance in the single items in the forensic sample.

Results

Distribution of symptoms

Alcohol-related problems were two to three times more common in the forensic psychiatric sample compared to the control sample (Table 1). An exception is memory lapses, which was about equally common in the two samples.

 

 

Table 1. Frequency of alcohol-related symptoms among the forensic psychiatric male patients (n=60) and the control group (n=106). The level of significance was not corrected for the risk of spurious significances. When employing the Bonferroni correction, statistical significance on the 5% and 1% levels disappear while results on the 0.005 level remain significant. The results should be looked at in an exploratory manner

 

Symptom question

Forensic group (%)

 

Control group (%)

Chi-square

Significance

1. Views consumption as too high

30

15

4.9

<0.05

2. Serious criticism

66

25

27.4

<0.005

3. Memory lapses

68

64

0.2

ns

4. Increased tolerance

52

18

22.7

<0.005

5. Eye opener

52

31

7.3

<0.05

6. Did something dangerous

55

38

4.6

<0.05

7. Received treatment

12

5

2.8

ns

 

 

The forensic sample reported on average 3.4 alcohol-related symptoms compared to 2.0 for the control sample (Mann-Whitney’s U = 1770.5; p<0.0001). 

Self-reported symptoms related to clinical diagnosis in the forensic sample

In total 25 percent of the forensic psychiatric sample had received a DSM-IV diagnosis due to dependency or abuse (15 subjects; 12 for abuse and 3 for dependence) after a thorough psychiatric investigation. In addition there were 4 multiple drug abusers and one person classified as having a multiple drug dependence. Seven subjects reported that they had received treatment due to alcohol problems and, of these seven subjects, two subjects did not receive a DSM-IV diagnosis. Rank correlations between single questions of alcohol-related symptoms and DSM-IV diagnosis ranged between 0.14 (did something dangerous) and 0.50 (views consumption as too high). The correlation between number of alcohol-related symptoms and DSM-IV diagnosis was rrho= 0.37 (p < 0.005).

Discussion

The purpose of the present study was to compare a male forensic psychiatric sample and a normal representative birth cohort of males with respect to self-reported alcohol habits.

Not surprisingly, the forensic sample showed a higher proportion of alcohol-related symptoms. With the exception of memory lapses (which were fairly common in both samples) all alcohol-related symptoms were two to three times more frequent in the forensic sample. Further, two subjects reported that they had received treatment because of their alcohol problems, although they were not classified as having a DSM-IV diagnosis for alcohol abuse or dependence.

Future research should be directed towards illustrating differences in symptom patterns in forensic versus non-forensic populations.

 

References

 

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, - fourth edition (DSM-IV), Washington DC: American Psychiatric Association.

Andersson, T., Mahoney, J., Wennberg, P., Kühlhorn, E. & Magnusson, D. (1999). The co-occurrence of alcohol problems and criminality in the transition from adolescence to young adulthood: A prospective longitudinal study on young men. Studies on Crime and Crime Prevention, 8, 169-188.

Angold, A., Costello, J. E. & Erkanli, A. (1999). Comorbidity. Journal of Child Psychiatry, 40, 57-87.

Collins, J. J. (1982). Alcohol careers and criminal careers. In  J. J. Collins. Drinking and crime: Perspectives on the relationships between alcohol consumption and criminal behavior (pp 152-206). London: Tavistock Publications.

Dobkin, P., Dongier, M., Cooper, D., & Hill, J. M. (1991). Screening for alcoholism in a psychiatric hospital. Canadian Journal of Psychiatry, 36, 39-45.

Harper, E. & Harper, D. W. (1981). Alcoholism and the forensic psychiatric patient: A comparative study. Canadian Journal of Psychiatry, 26, 108-109.

Helzer J. E., Pryzbeck, T. R. (1985). The co-occurrence of alcoholism with other psychiatric disorders in the general population and its impact on treatment. Journal of Studies on Alcohol, 49, 219-224.

Karlberg, P., Klackenberg, G., Klackenberg-Larsson, I., Lichtenstein, H., Stensson, J. & Svennberg, I. (1968). The development of children in a Swedish urban community. A prospective longitudinal study. Acta Paediatrica Scandinavica Supplement, 187.

Klackenberg, G. (1971). A prospective longitudinal study of children: Data on psychic health and development up to 8 years age. Acta Paediatrica Scandinavica, 224.

Nystrom, M, Persalo, J. & Salaspuro, M. (1993). Screening for heavy drinking and alcohol related problems in young university students: the CAGE the Mm-MAST and the trauma score questionnaire. Journal of Studies on Alcohol, 54, 528-533. 

Wennberg, P. (1996). The Alcohol Use Disorders Identification Test (AUDIT): A psychometric evaluation, Reports from the Department of Psychology, Stockholm University, No. 811.

Wennberg, P. & Dåderman, A. M. (1999). Perception of self-report questions concerning alcohol habits in a male forensic psychiatric sample. Poster, German J Psychiatry  http://www.gwdg.de/~bbandel/gjp-poster-wennberg2.htm