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Violent behavior, impulsive decision-making, and anterograde amnesia while intoxicated with Flunitrazepam and alcohol or other drugs: A case study in forensic psychiatric patients
Department of Forensic Psychiatry, Stockholm; Stockholm University, Sweden.ORCID-id: 0000-0002-8562-5610
Department of Forensic Psychiatry, Stockholm, Sweden.
Department of Forensic Psychiatry, Stockholm, Sweden.
Department of Forensic Psychiatry, Stockholm, Sweden.
Visa övriga samt affilieringar
2002 (Engelska)Ingår i: The journal of the American Academy of Psychiatry and the Law, ISSN 1093-6793, E-ISSN 1943-3662, Vol. 30, nr 2, s. 238-251Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

It is known that many male juvenile delinquents commit violent crimes while intoxicated with flunitrazepam (FZ), often in combination with alcohol or other drugs. We have also noted the combined abuse of FZ with, for example, alcohol in male forensic psychiatric patients. Our objective was to study violent behavior, impulsive decision making, and amnesia in male forensic psychiatric patients who were intoxicated predominantly with FZ, to increase knowledge of the abuse of FZ in vulnerable subjects. We studied five forensic psychiatric patients, all of whom were assessed in 1998. All of the subjects reported earlier reactions to FZ, including hostility and anterograde amnesia. At the time of their crimes they were all intoxicated with FZ, often in combination with alcohol or other drugs, such as amphetamine or cannabis. In contrast to their behavior based on their ordinary psychological characteristics, their crimes were extremely violent, and the subjects lacked both the ability to think clearly and to have empathy with their victims. Our observations support the view that FZ abuse can lead to serious violent behavior in subjects characterized by vulnerable personality traits, and that this effect is confounded by the concurrent use of alcohol or other drugs. It is evident that FZ causes anterograde amnesia. Previous research and the results presented herein allow us to draw the following conclusion: on the basis of the neuropsychopharmacologic properties of FZ, legal decisions, such as declaring FZ an illegal drug, are needed in countries where it is now legal.

Ort, förlag, år, upplaga, sidor
Bloomfield, CT, USA, 2002. Vol. 30, nr 2, s. 238-251
Nyckelord [en]
Rohypnol, violent offences, forensic psychiatry, case study, psychological consequences
Nationell ämneskategori
Rättsmedicin Psykiatri
Forskningsämne
SAMHÄLLSVETENSKAP, Psykologi
Identifikatorer
URN: urn:nbn:se:hv:diva-4977OAI: oai:DiVA.org:hv-4977DiVA, id: diva2:581287
Projekt
Dyslexi bland rättspsykiatriskt undersökta män: Psykologiska, sociala och biologiska indikatorerTillgänglig från: 2012-12-30 Skapad: 2012-12-30 Senast uppdaterad: 2017-12-06Bibliografiskt granskad
Ingår i avhandling
1. “Dr Jekyll and Mr Hyde?”: Abuse of potent benzodiazepines, exemplified by flunitrazepam, in mentally disordered male offenders
Öppna denna publikation i ny flik eller fönster >>“Dr Jekyll and Mr Hyde?”: Abuse of potent benzodiazepines, exemplified by flunitrazepam, in mentally disordered male offenders
2005 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Flunitrazepam (FZ) is an example of a sedative-hypnotic benzodiazepine whose pharmacokinetic properties include a rapid onset of action and an intermediate duration of action. It has a high affinity to central benzodiazepine receptors and affects them profoundly. These properties, and its profile of activity, increase the probability of abuse by those who have access to it. Known side effects of FZ are abuse and amnesia. FZ is widely abused and it has become a drug of choice among opioid abusers, as a club drug, and as a classic “date-rape” drug. FZ is often involved in fatal intoxication. It is therefore expected that FZ abuse is common in serious offenders. I have studied the reasons for FZ abuse and mapped the prevalence of the abuse, with the objective of studying the personalities and the background factors of the abusers, and of drawing some conclusions about assessment procedures of FZ abuse and the position of FZ in society.

The participants in the studies summarised here were fifty-six juvenile delinquents from Swedish youth correctional institutions, aged 14-20 years, and sixty non-psychotic male offenders referred for a forensic psychiatric evaluation (FPE), aged 16-35 years. The participants answered questions regarding their abuse, and this enabled us to understand why they abused just FZ (and not another substance). The participants also completed a number of self-reported inventories, which enabled us to obtain measures of personality traits. They were also rated for psychopathy. Five forensic psychiatric cases of FZ abusers were studied in more detail. Furthermore, the forensic psychiatric participants’ psychiatric diagnoses, and both groups’ crime-related measures, were obtained from their files.

About 40% of the juvenile delinquents and 30% of the offenders referred for a forensic psychiatric evaluation abused FZ. The main reason for the FZ abuse was to change a perception of reality and to obtain an increased feeling of power and self-esteem, a feeling that everything was possible. Both samples of offenders differed from the normal population in many personality traits, suggesting that the participants possessed a high level of vulnerability for developing mental disorders, but only a few differences in personality traits were found between FZ abusers and non-FZ abusers. The juvenile delinquent FZ abusers had higher scores than non-FZ abusers in the verbal aggression and sensation-seeking boredom susceptibility scales. In the juvenile sample, FZ abuse was associated with the abuse of amphetamines and/or cocaine, cannabis, and opiates, and with childhood psychological/psychiatrical contact, with living in a metropolitan housing area, and with recidivism into crimes leading to care in a juvenile correctional institution. In this sample, FZ abuse was also associated with weapons offences and narcotics-related crimes. In the forensic psychiatric sample, FZ abuse was significantly associated with previous admission to an FPE, and convictions for robbery, for weapons-related offences, for narcotics-related offences and for theft. The results show that FZ is more common in offenders who score high on Facet 4 (Antisocial) in the Hare psychopathy model, and that FZ abuse has high correlation with Item 20 (Criminal versatility). All of the FZ abusers reported side effects from FZ that resulted in the brutality of their violent acts and anterograde amnesia. FZ abusers, when intoxicated with FZ, had a reduced capacity for both empathy and anticipatory anxiety, in contrast to their “daily” behaviour and “ordinary” (i.e., without the influence of the FZ) personality characteristics. They were not characterised by classic characteristics of psychopathy, such as lack of empathy. This may indicate that FZ induces psychopathic-like state-dependant (FZ intoxication) traits, and temporary dissociate states (“Dr Jekyll and Mr Hyde”?).

In conclusion, FZ abuse is common in the population of young offenders with mental disorders, and FZ is often used for nonmedical purposes. The practical implications of these conclusions are that clinicians and those who develop or manage therapeutic programs should be aware of FZ abuse when choosing the most effective treatment for male offenders. General practitioners who prescribe potent sedative compounds should be aware of their possible adverse effects. The availability of FZ should be limited further, because FZ is frequently abused in vulnerable male offenders, and because FZ has serious adverse mental health-related effects and is related to robbery and weapons‑related crimes.

Ort, förlag, år, upplaga, sidor
Stockholm: Karolinska Institutet, 2005. s. 124
Nyckelord
Flunitrazepam (FZ) abuse, side effects of FZ, offenders referred to forensic psychiatric evaluation, juvenile delinquents, personality traits, psychopathic traits and lifestyle (PCL-R)
Nationell ämneskategori
Medicin och hälsovetenskap
Forskningsämne
SAMHÄLLSVETENSKAP, Psykologi
Identifikatorer
urn:nbn:se:hv:diva-5047 (URN)91-7140-584-4 (ISBN)
Disputation
2005-12-02, Bi 3-221, Alfreds Nobels Allé 10, Huddinge, 10:00 (Svenska)
Opponent
Handledare
Projekt
“Dr. Jekyll och Mr. Hyde beteende” bland manliga kriminella ungdomar i samband med alkohol kombinerad med bensodiazepiner: Biologiska och psykologiska indikatorerDyslexi bland rättspsykiatriskt undersökta män: Psykologiska, sociala och biologiska indikatorer
Anmärkning

1. Följande forskningsfinansiärer (det går inte att skriva in dem i följande ruta): Preparation of this thesis was supported by a doctoral fellowship from the Swedish Foundation for Care Sciences and Allergy Research. I have also been twice awarded a scholarship for research with violent offenders from the Swedish Carnegie Institute, and a scholarship for an “in-depth study into alcohol and drugs” from the Swedish Medical Society of Addiction Medicine. The Swedish National Board of Forensic Medicine (Rättsmedicinalverket), The Swedish Alcohol Research Fund, Karolinska Institute, Lund University, Stockholm University, and The Söderström-Königska Foundation also supported this thesis by grants.

2. Forskningsämne är rättspsykiatri (detta går inte heller att välja i rutan ovan)

Tillgänglig från: 2013-01-11 Skapad: 2013-01-10 Senast uppdaterad: 2014-01-10Bibliografiskt granskad

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